Connection ...

... love and intimacy are among the most powerful factors in health and illness, even though these ideas are largely ignored by the medical profession. ... I am not aware of any other factor in medicine - not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery - that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.

Dean Ornish, MD

Dean Ornish, an American cardiologist and founder of the Centre for Integrative Medicine in San Francisco, (best known for his use of a very low fat diet to reduce or reverse coronary artery disease), has also spent a number of years studying the effects of love and intimacy - an open heart - on our health and wellness.

In his 1997 book, Love and Survival: The Scientific Basis for the Healing Power of Intimacy, Ornish writes:

The real epidemic in our culture is not only physical heart disease, but also what I call emotional and spiritual heart disease - that is, the profound feelings of loneliness, isolation, alienation, and depression that are so prevalent in our culture with the breakdown of the social structures that used to provide us with a sense of connection and community.

He goes on to say that loneliness and isolation affect our health in several ways:

1.  They increase the likelihood that we may engage in behaviours like smoking and overeating that adversely affect our health and decrease the likelihood that we will make lifestyle choices that are life-enhancing rather than self-destructive. 

2.  They increase the likelihood of disease and premature death from all causes by 200-500 percent or more, independent of behaviours, through different mechanisms, many of which are not fully understood.

3.  They keep us from fully experiencing the joy of everyday life.   

In short, anything that promotes a sense of isolation often leads to illness and suffering. And anything that promotes a sense of love and intimacy, connection and community, is healing.

So, what does this say to us as helpers? It reminds us of the vital importance of creating and sustaining supportive relationships in which we can be ourselves, transparently and authentically. Compassion fatigue, burnout and accumulated grief all cause our hearts to close and we disengage from family and friends, colleagues, and care recipients. Wellness opens our hearts, enabling us to be emotionally aware, to disclose our emotions in a mindful way, to listen carefully to what the other person is feeling, and to acknowledge that person's feelings with empathy, caring and compassion.

It can be difficult, at times, to maintain healthy connections but, as we can see above, its worth making the effort. I remember becoming more and more isolated over the years of caring for my husband. I felt deeply connected to him but had only a few other  relationships that I continued to nurture actively. There just weren't enough hours or energy in the day.

It wasn't until the last three years of his life, when Derrick became confined to bed and I had to organize a rota of friends to stay with him whenever I left the house, that I realized how much I had missed and needed mes amis. As different folks came to the house on Wednesday and Saturday mornings, I went out to do errands and then returned to have a cuppa with whomever was there. Those visits were God-sends. Not only was I able to connect with loved ones, but with loved ones who got our situation because they'd just spend the morning with my husband. We were able to have honest, open-hearted conversations that allowed our care and compassion to flow and it was so good.

So, if you have been too busy, too tired, too scattered, too sad, too irritable or too fed up to connect with your friends for the past while, why not consider giving someone a call and arranging a date for lunch or coffee or a chat on the phone. It's always okay to limit the time from the onset if you're really tired or afraid of getting overwhelmed - "I only have twenty minutes, but I've been missing you and wanted to connect." Choose who you call wisely and you may be surprised to see just how much better you feel after the conversation.

ps  I will be re-connecting with loved ones over Spring Break and the Easter weekend, myself, so I won't be back in the office until Tuesday April 2nd. In the meantime, I wish each of you a very Happy Easter and all the blessings and veriditas of Spring.  Jan

Veriditas II ...

A person who toils more than her body can bear

is rendered useless in her spirit

by ill-judged roil and abstinence.

Living hopelessly and joylessly, that person's sense often fails.

Hildegarde of Bingen

Hi everyone...  Last spring, I wrote a blog post on self-care called, Veriditas. At the time, I understood veriditas to mean the greening force of spring but I was far from comprehending the depth and power of the concept.

This year, after almost twelve months of reading about Hildegarde of Bingen (an amazing German abbess who, at a time in the 1100's when few women could read, was an early feminist, ecologist, herbal healer, poet, playwright, mystic, and composer) and after a month-long mandala retreat based on her writings, I have a much deeper understanding of both the woman and her veriditas. And I think she has much to say to those of us who have become desiccated and arid (ariditas) through caring for others while not caring so well for ourselves.

The verse above, taken from one of Hildegarde's letters, is a perfect description of my own state in the last weeks of my husband's life. I was physically exhausted, my spirit was dry through roiling turbulence and abstinence from the things that might have kept me moist, juicy and verdant. I felt little hope or joy, and as many will tell you, my sense - common or otherwise - was definitely failing.

Hildegarde saw veriditas as that life force which unifies all of life. She was most interested in the sense of life, radiance, vitality and aliveness in all creatures. She saw veriditas as the green sap that makes life possible. As author, Christine Painter, writes:

This green fluid, that is the source of life, is hidden below the earth, in the the roots of things waiting to burst forth in springtime with newness. Rain elicits this response. Hildegarde believed that humans draw forth this same green sap into our beings through the breath and the soul. The breath is the animating force, drawing in moisture and life.

Though Hildegarde was, of course, bound by the "science" and theology of her times, there is still great wisdom in many of her ideas. Let's try to apply some of them to our own lives:

Imagine where in your life you experience the dryness of ariditas. Where do you encounter complete lack of nourishment or anything to sustain you? Does any part of you resonate with this notion of barrenness and desiccation? Where have you become depleted in yourself and in your service to others? (Be sure to hold these dry and arid places with the utmost gentleness and compassion. This is not a time for judgement or self-criticism.)

Then, breathe the moist and verdant energy of veriditas into your body, your mind, your emotions and your spirit. Allow it to fill your being with life-giving greening power. Then exhale, letting go of all the dryness and releasing its hold on you. Do this for several minutes.

Now, allow yourself to consider these three questions for reflection adapted from Christine Painter:

1.  Where in your life do you experience the greatest dryness or ariditas?

2.  Where is the greening of life most abundant for you? What are the things which bring you most alive and in connection with the greening life force at work in the world?

3.  Could you make some time to immerse yourself in one of these activities, or some small aspect of it, this week?

As you can see, veriditas isn't just a reflection of the greenness of nature, it is reflective of the very state of our true, authentic selves. We each have the capacity to bring forth new life just as the earth brings forth greenness. Becoming more aware of the quality of greenness of the earth helps us to see where in our aridity we need new growth.

When Your Family Physician Retires...

I went to my family doctor for my biannual physical a few weeks ago and was surprised and just a little shaken to learn that he will be retiring from the practice component of his work this coming September. I had been expecting to hear this news sooner or later but the reality felt worse than the anticipation.

I felt a little as though I was a four-legged stool that had had one leg kicked out. I have known our physician since he was an intern at the teaching hospital in which I worked in the 70's and, over the years of my husband's life with and death from cardiomyopathy, we spoke by phone several times a week and he visited us at home for the three years that Derrick was confined to bed. Over tea and cookies after he'd examined his patient, we came to know him better and liked him all the more. He visited us in hospital during the last week of Derrick's life and both called to check on me after Derrick's death and attended his funeral. He has walked an intense portion of life's journey with us and I will miss him and his kind, steady, support.

I don't think that people generally reflect deeply upon the importance of their relationships with family physicians until they or someone they love is really ill or until those physicians are leaving or have already left. We certainly don't do that as a society, a fact demonstrated by the absence of research into the emotional impact of physician retirement on seriously and/or chronically ill patients and their care partners. And yet, that impact can be great, even destabilizing in some cases.

As with any attachment, particularly a dependent one, the breaking of the physician-patient-family care partner relationship is a loss that evokes grief. In the case of patients and care partners already experiencing chronic sorrow and reduced social support, that grief can feel overwhelming. Even relatively short physician absences can evoke sadness, anger, anxiety and distress.

I remember when our physician played a game of hockey and badly injured his neck, requiring surgery and time off work for most of the last six months of Derrick's life. It was an enormous loss and source of concern for us - worry for our physician, himself; fear about loss of continuity of care and of all the facts rattling around in his head that I might or might not be able to remember on a given day; loss of his relatively easy availability, based on his belief that home palliative care was impossible without physician accessibility and home visits; and his willingness to entertain "outside the box" solutions for Derrick's longterm pain. His absence brought into sharp relief all the qualities with which he'd graced our lives over the years.

I think it is important that we make space to grieve the loss of such a significant relationship whenever a physician retires, is absent for a long period, or when a patient dies and the degree of contact with the care partner changes - space for the grief of physician, patient, and family care partner alike.

It matters that we give each other time to acknowledge the alteration in the previous pattern of life, to say goodbye, and to express unfinished business, concerns and gratitude - aside from all the administrative details. We need a chance to say what the relationship has meant to us. At it's best, the physician-patient-family care partner relationship is one of mutual care, compassion, learning and partnership - and, thus, one deserving of its grief.

So, as it draws to a close, I would like to take the opportunity to publicly acknowledge and thank Dale Stogryn, a fine man, a fine physician and an excellent medical educator, for a twenty-five year relationship of care, respect, compassion and great medicine. I am glad that you will continue with your work in medical education but those of us in your practice will be the poorer for your absence.

Two New Literary Resources for Care Partners ...

Good morning, everyone! I'm writing today to tell you about two new literary resources for feeding the souls of those who care for others. The first is brand new and the second is new-to-me. I hope that both will be a source of strength, hope, optimism and healing as you continue your care partnering at home and at work.



1. Brain Injury Journey - Hope, Help, Healing

Several times in the past I have spoken of, and linked to, the blog of Barbara Stadhura a great writer, journal workshop leader, and former care partner for her husband who has now recovered substantially from a brain injury following a motorcycle accident. Barbara is now the Editor-in-Chief of Brain Injury Journey Magazine, an exciting new publication from Lash and Associates, a leading publisher of brain injury information.

In the words of their publication introduction:

This magazine is a vehicle for information, support, and resources for the entire brain injury community. Designed to help persons with brain injury, families, caregivers, and providers successfully navigate challenges and live a full and satisfying life, each issue offers empowering personal stories, interviews with experts, clinical updates, research findings, and book reviews. Above all, it provides a community to enhance hope and foster healing after brain injury. 

The best news of all is that email subscriptions to the magazine, which will be published for the first time in April, are free. You can also order a print edition, published 6 times a year, for $48 (US).

With Barbara at the helm, this magazine can't help but provide an authentic, practical, and encouraging  information source for the whole brain injury community. Congratulations to Barbara and her team!


2.  Panhala Website

Anyone who reads this site regularly or who comes to my workshops will already know of this predilection - for those who don't or haven't,  I love poetry! A few weeks ago, quite by accident, I came across this website and, all of a sudden, I was in poetry and photography heaven.

Panhala, according to the website, is Hindi for "source of fresh water" (more or less). The purpose of the group is to " share poems and prose to make the day a little brighter".  The postings on this site are excellent, and the photography, just beautiful. Perhaps try the poem called Laughter  by Hafiz first - it will make you smile all day!

TED Talks for Helpers ...

For the past few weeks, Vancouver's been buzzing with the news that the popular TED Talks  (Technology, Entertainment, Design Talks) will be bringing their West Coast conference to Vancouver  in 2014.

Though beyond the financial ability of most folks to attend, TED's ideas worth sharing can be accessed via the Internet and many of the past speakers have addressed topics of interest to care partners and to compassion fatigue sufferers, educators or specialists. Some of these talks include:

1.  Karen Armstrong:  Let's Revive the Golden Rule,  The Charter for Compassion

2.  Nancy Berns:  On the Space Between Joy and Grief   

3.  Tim Brown:  Tales of Creativity and Play 

4.  Brene Brown:  Listening to Shame,  The Power of Vulnerability

5.  Elizabeth Gilbert:  Nurturing Creativity 

6.  Carl Honore:  In Praise of Slowness 

7.  Nigel Marsh:  How to Make Work-Life Balance Work 

8.  Kristin Neff:  The Space Between Self Esteem and Self Compassion 

9.  Mattieu Ricard:  Habits of Happiness 

10.  JK Rowlings:  The Fringe Benefits of Failure 

11.  Saalman Sana:  Compassion for Care 

12.  Ernesto Sirolli:  Want to Help Someone?: Shut Up and Listen!

While none of the talks listed above are aimed at care partners, specifically, we can each draw lessons from them to enrich our lives.  Enjoy!

  

A New Compassion Satisfaction Resource ...

Compassion satisfaction is the pleasure you derive from being able to do your work. For example, you may feel like it is a pleasure to help others through what you do at work. You may feel positively about your colleagues or your ability to contribute to the work setting or even the greater good of society through your work with people who need care.

Beth Hudnall Stamm, PhD

Hi everyone! Here is a new book for your compassion fatigue library. Compassion Satisfaction: 50 Steps to Healthy Caregiving was published in the fall of 2012 by Patricia Smith, an American CF Specialist and author of the first popular literature on compassion fatigue. (Her first books were To Weep for a Stranger: Compassion Fatigue in Caregiving and Healthy Caregiving: A Guide to Recognizing and Managing Compassion Fatigue.)

Patricia's new book on Compassion Satisfaction (CS)  offers several brief, readable chapters divided into three sections, one each for caregivers, care recipients and organizations. It's the perfect book to keep handy for quick inspiration and refreshment as you begin a day of care-giving or to dip into before going to bed at night.

Compassion satisfaction is an important concept to remember any time we speak about compassion fatigue. Our helping experiences are complex, not all bad nor all good. There is usually a mix of stressors and rewards. Reflecting upon the rewards helps us to balance the difficulties and reminds us why we chose to be helpers in the first instance. It brings into bold relief what keeps us going as we do the work. When we recognize what sustains us, we can increase our focus in these directions. 

In her book, The Compassion Fatigue Workbook, another CF Specialist, Francoise Mathieu, offers these questions (paraphrased) for reflection and journalling on compassion satisfaction:

1.  What made me choose this work?

2.  What keeps me going and sustains me, as a person and a professional, given the challenges of my work?

3.  What concrete strategies have made a significant difference for me and have allowed me to remain healthy and well in this work? (Strategies at work and strategies at home)

4.  If I were to do it all over again, is there anything I would do differently?

5.  Reflecting on successes, how have I made a difference to others?

6.  Can I think of a particular client, patient or loved one whose story has touched me profoundly in a positive way? What is it about his or her story that has moved me?

7.  Is this still the right work for me?  (p136) 

Why not make a hot drink, curl up with your journal, and reflect for a little while upon what it is about your care-giving that still makes your heart sing?

  

A Gift For and From the Heart ...

Hi everyone! February is Heart Month and the home of Valentines Day and many of us are beginning to think of Valentine gifts for our loved ones - the traditional chocolates, flowers, lingerie and poetry or more adventurous gifts like exotic cruises or white water expeditions. But what about considering a more long-lasting gift of the heart - like a heart-healthy diet for the whole year?

I love healthy, real food - the way it looks, the way it smells, and most especially, the way it tastes. Last night I made an amazing technicolour red quinoa stew with onions, mushrooms, squash, spinach, slivered almonds and dried figs. Mmmmmm-MMMMM! Gorgeous and delicious and so full of healthy nutrients that one cupful sustained me for the whole evening. I wish my husband had been there to enjoy it with me. Derrick cooked for me for 19 years and I really believe that cooking healthy food for those we love is one of the best ways we can show our love. (Following in his footsteps and learning to make a healthy dinner for myself was quite a transition for the girl whose family once joked that if anything happened to Derrick, Jan would die of a Cheerios overdose!)

Those of you who spend all day caring for others - at work, at home, or both -  may find yourselves  exhausted and stymied when it comes to another week of meal planning. So here is a Valentine gift for each of you - a list of 5 of my favourite healthy-food websites and 5 of my favourite healthy-food cookbooks, each with nutritious, easy-to-prepare meals and beautiful pictures. (It can be a gift to yourself just to spend a few minutes looking at the photographs!)

Websites

1.  Healthful Pursuit

2.  Cooking Light

3.  Heart and Stroke Foundation

4.  Food52

5.  The Healthy Foodie

Cookbooks 

1. Lighthearted Everyday Cooking by Anne Lindsay

2.  Eating For Energy Without Deprivation: The 80-20 Cookbook by Patricia Chuey and Diana Steele

3.  12 Best Foods Cookbook by Dana Jacobi

4.  Start Fresh! Your Guide To Midlifestyle Food and Fitness by Diane and Dr Doug Clement

5.  The LooneySpoons Collection by Janet and Greta Podleski

So, why not give a Valentine gift that keeps on giving - both to you and to the ones you love?