Holiday Greetings ...

I am, like many of the rest of you, up to my ears in holiday preparations. The tree is up, likewise the Dickens Christmas Village. My favourite carols fill the air. I have thought about doing some baking, but that's about as far as that's gone!

Next week, I will make my annual trip to Nanaimo, on Vancouver Island, with my car filled with gifts for family and friends and my heart filled with the anticipation of happy hours spent in the warm love and laughter of dear ones. I will be away until December 28th so won't be posting again until the New Year.

In the meantime, I wish you the blessings of peace, joy, healing and comfort this holiday season and leave you with these words from Grace Cathedral, San Francisco, found in this year's Callanish Society Christmas card:

We give thanks for places of simplicity and peace.

May we find such places in ourselves.

We give thanks for places of freedom and beauty.

May we find such places in ourselves.

We give thanks for places of refuge and love.

May we find such places in ourselves.

May we begin to mend the outer world

According to the truth of our inner life.

Self Care Books for the Holidays ...

Yesterday morning, I spent a few hours looking through books at a friend's bookshop in Vancouver. I was looking for Christmas presents and for some new books that I could recommend to you in today's blog post - and I have to say, I struck it rich. Here are three of the books that topped my list:

1. A Life of Being, Having, and Doing Enough by Wayne Muller (2010)

In this sequel to Sabbath: Finding Rest, Renewal & Delight in Our Daily Lives, Wayne Muller, founder of Bread for the Journey, a nonprofit organization that supports community organizing, explores the notion of sufficiency - not "the cramping fear of scarcity, the bloated saturation of over-abundance, but the gentle, effortless release of easy sufficiency".

He addresses the difficulty we have taking a Sabbath, slowing down, or stopping for replenishment and renewal - the difficulty of allowing our work to feel sufficient for the day. He challenges us to listen to our inner thermostats for signs that we have done enough, signs that it is time to take a break or stop altogether.

Wayne, a heart attack survivor who must now live within the limits of his energy, identifies obstacles to living a life of enough - our to-do lists, the fantasy of getting caught up, our inability to slow down or to handle silence and stillness, our harsh self-judgement and our addiction to endless self-improvement and progress.

He also describes the blessings on the road to a life of enough - the ability to see the value in small things, to have mercy upon ourselves, to see the growth that can emerge from loss, to enjoy the benefits of good company, to recognize the sufficiency of presence, and to see the value of bearing witness.

2. In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Peter Levine (2010)

In this book, American medical biophysicist and psychologist, Peter Levine, shares the essence and underpinnings of his life's work - Somatic Experiencing - a type of body psychotherapy used for healing psychological trauma.

In a style that reads like a mystery novel, Peter clearly and descriptively explains that trauma resides in the "unspoken voices" of our bodies. Using animal ethology (the study of animals in their natural environments), brain research, native healing practices and his lengthy clinical experience, he shows how traumatic experiences result in psychological injuries that can be transformed by paying attention to the natural healing processes deep within our bodies.

In chapters entitled, The Power of an Unspoken Voice, The Changing Face of Trauma, Immobilized by Fear: Lessons Learned from Animals, From Paralysis to Transformation, A Map for Therapy, The Body as Storyteller, and Body, Emotion & Spirituality: Restoring Goodness, Peter leads us through a body-based healing process that acknowledges our frozen trauma responses and safely paces our developing awareness and mastery of our physical sensations and feelings. He teaches us to self regulate and to allow for the completion of survival responses that were inadvertently cut short at the time of the trauma.

The integration of body psychotherapy and "talk therapy" is the new frontier in trauma work and, in my opinion, there couldn't be a better introduction to it than this visionary book.

3. Haiku Mind: 108 Poems to Create Awareness & Open Your Heart by Patricia Donegan (2008)

Patricia Donegan, poet, translator, and promoter of haiku as an awareness practice, has written this lovely commentary on the haiku of many poets, including herself.

She begins the introduction with a haiku by Shiki Masaoka, -

Cutting a pear

sweet drops drip

from the knife

and says-

I wanted to write this book to share the idea of "haiku mind" -

a simple yet profound way of seeing our everyday world and living our lives

with the awareness of the moment expressed in haiku -

and to therefore hopefully inspire others to live with more

clarity, compassion and peace.

A fine haiku presents a crystalline moment of heightened awareness

in simple imagery ... However, this moment is more than

a reflection of our day-to-day life - it is a deep reminder

for us to pause and to be present to the details of the everyday.

Patricia goes on to share 108 haiku, each with a brief commentary and a short biographical note about the poet who had written it. A lovely read with which to begin or end the day or with which to enjoy a restful cup of tea.

I hope you will enjoy some of these books over the holidays and that you will feel free to add to the list any others you think your fellow caregivers/carepartners might like to read.

Holiday Help for Family Caregivers ...

Family caregivers spend endless time and energy caring for loved ones who are ill, disabled or frail and are often unable to participate in the usual traditions and activities of the season. Thoughtful assistance and gifts from those who love them can make all the difference to the quality of their holidays.

Here are some ways you can help the family caregivers in your life:

1. Ask what's needed or wanted before you shop, bake or make plans. Every caregiving situation is different and the needs of each caregiver are different as well. I remember receiving several lovely packets of bath salts and oils one Christmas while caring for my husband. They would have been wonderful to use had we had a bathtub!

2. Consider that while the gift of an afternoon's concert, play or special event might be much appreciated, it needs to come with the second gift of someone qualified to stay with the care recipient so the ticket can be used.

3. Gifts of food can bring real relief from the monotony and fatigue of cooking, but remember to ask, first, regarding personal preferences, allergies and dietary restrictions. We frequently passed on to others casseroles whose salt content was too high for my husband to eat. (Including a copy of the recipe can help to reduce anxiety in this regard.)

4. Try to avoid gifts that need assembling, that are outside the caregiver's previous experience or that are very complicated (technological devices with multiple functions) unless the caregiver has asked for it, specifically. (Impaired cognitive function is a hallmark of caregiver stress and most caregivers find it hard enough to remember where they put their keys , let alone how a new device works.)

5. Avoid giving anything that will need special care - this includes anything from a delicate plant to "a nice pet to keep you company". Now is not the time to inadvertently add to the caregiver's burden.

6. Consider safety in all gift giving. eg No glass figurines, knife sets, or barbecue lighters for caregivers of children with aggressive or impulsive behavioural disorders, unless there is safe storage space that is out of sight.

7. Consult with the caregiver before buying gifts of perfume or other scented materials that might aggravate allergies or respiratory conditions. (Their own or that of the care recipient.)

8. Consider gifts of your time and presence - "gift certificates" for mowing the lawn or shovelling the walks on a regular basis or for sitting with the care recipient so the caregiver can get out for errands or respite, or for short biweekly or monthly visits for a chat and support. (But be sure that you can follow through with whatever you promise.)

9. Offer to buy and put up the Christmas tree or other decorations - but be sensitive to the loss involved in changing a holiday tradition. Check at each stage in the process to see if that step is something that the caregiver would rather do alone. Perhaps you could buy and set up the tree and lights and then leave the decorating to them or perhaps they will want you to do the whole job. Just keep asking.

10. Offer transportation to shopping malls or to doctors appointments. Return library books or DVD's.

11. Offer to do the caregiver's holiday shopping or wrapping or to help them to navigate shopping on the internet.

12. Talk about plans for holiday dinners well in advance. But be prepared to change plans at the last moment if the care recipient is ill or the caregiver is too tired. Ask what will make life easiest for the caregiver - to have you make and deliver a meal on plates then leave, to eat altogether at your house or theirs, to have a pot luck or share the cooking, to go out for a meal?

13. If you're "going home for Christmas", ask if it would be easier if you stayed in a nearby hotel.

These are just a few possibilities. Please add your own ideas to the list. The important thing is to be thoughtful, empathic and accepting in the face of the caregiver's stress, indecisiveness and desire to hold on to the things that have meant the most to them.

Remembering ...

Every year on November 11th, sometimes in clear brilliant sunshine, sometimes in blustering winds and sheets of rain, we gather around cenotaphs across the country to honour and show our gratitude to those who have given their lives or their health for our safety. Those who have come home injured, whether with physical wounds or operational stress injuries, have come back with their lives changed forever and their altered lives alter the lives of all who love them, particularly their family caregivers/ carepartners.

These family caregivers are as affected by their loved ones' injuries as their loved ones are themselves. No area of their lives is untouched. And yet, all too frequently, family caregivers are the unsung heros of our wars and peacekeeping missions. They are the glue holding families together during long or repeated deployments and once their partners are injured, they take on a myriad of additional responsibilities as nurses, rehab specialists, psychotherapists, cheerleaders and advocates. It is through their support and daily efforts that the members of our military have as much as they do, in order to recover.

And yet, this support for recovery comes at a cost. Energy and resources that would otherwise have been spent nurturing the growth and development of family life must be diverted to recovery from injuries and, worse, to fighting a bureaucracy that seems to have little access to common sense, empathy or compassion. Already overwhelmed by the enormity of the task of recovery and adjustment, veterans and their family carepartners can face an unwieldy, inefficient and seemingly uncaring response to even their simplest requests.

This week, however, a wide ranging group of deeply caring Canadians, led by the vision and efforts of people like Allan De Genova, took a giant step toward supporting our wounded veterans and other first responders and their families with the opening of Honour House in New Westminster, BC.

Set on a quiet street not far from the New Westminster Armoury and the beautiful Japanese Gardens where I played as a child, Honour House is a fully accessible residence that will temporarily house up to ten families who must relocate to Greater Vancouver for a loved one's treatment and rehabilitation and who, in the past, would have endured long separations at a time when they needed each other most.

The ability to stay together as a family unit during long months of recovery will make all the difference to the quality of that recovery for the whole family. Hopefully Honour House is just the first of at least ten provincial houses that will support these families who have given so much for us. And, hopefully, the federal government will come to understand the importance of such support and add federal funding to the mix for the houses yet to come.

Cumulative Grief in Healthcare Professionals ...

Earlier in the fall, I mentioned that I believe there is a missing, or at least underemphasized, component in our consideration of compassion fatigue in health care professionals. That component is cumulative grief.

Most of us are familiar with the Baranowsky-Gentry model of compassion fatigue which states that primary traumatic stress (the trauma that happens to us directly or that we witness directly), secondary traumatic stress (the trauma we experience indirectly through knowing about trauma in others' lives) and burnout (the chronic stress of perceived workplace demands exceeding perceived resources) converge in the life of the helper to cause compassion fatigue, a diminished capacity for or interest in being empathic with another's suffering.

As I have worked with family caregivers, I have modified this model a little to say that primary traumatic stress and secondary traumatic stress, in the presence of burnout and Chronic Sorrow, can lead to compassion fatigue. I have found this change to be helpful in emphasizing that CF is primarily a trauma issue that occurs in conjunction with burnout - not a form of burnout, itself, - and that the grief of Chronic Sorrow, extending from a loved one's diagnosis until his or her death, may also contribute to family caregivers' vulnerability to CF.

Once I had adjusted my CF thinking to incorporate the Chronic Sorrow of family caregivers, I began to wonder about the cumulative grief of healthcare professionals.

Grief is our normal, hardwired, healing response to loss and it will generally heal itself if we stay out of the way and support rather than blocking the natural process. But what if we work in an environment where loss is the norm? What if we form caring attachments to patients and families over and over again only to have the patients die and the families to move on with their lives? What if we work in environments that do not make time and space available to process our own grief or, worse, those that ridicule and shame such "weakness"?

There is a significant and growing literature base, still at the descriptive stage for the most part, focused on cumulative grief, which is defined as:

... our emotional response to the occurrence of multiple deaths,

either at the same time or in serial fashion,

without sufficient time or opportunity to

adequately grieve for each person who has died.

P. Marino (1998) Paraphrased

Phenomenological studies on cumulative grief have emerged from the fields of palliative care, oncology, critical care, paediatrics, gerontology and advanced nursing practice, particularly since the mid-1990's. There are also several professional magazine articles offering advice on how to cope with this accumulated grief, testifying to the importance of the topic at the grass roots level of practice. Last week's episode of CBC's White Coat, Black Art called, "When Your Life is Circling the Drain", reflects the impact of multiple deaths on young medical residents.

Not all work-related losses are considered traumatic, especially when healthcare practitioners have been able to provide "a good death" for both the patient and the family. Thus cumulative grief doesn't fit easily into our currently-held understanding of CF. However, these losses are real and can have a significant impact upon us, especially if left unattended. Do they actually contribute to increased vulnerability to CF? We don't know that yet but it is a rich area for further research.

In the meantime, I will continue to address cumulative grief within the context of CF in my healthcare workshops as it almost invariably and spontaneously comes to the fore.

Photo by BigStock Photos

Companioning through Grief...

Although it is a bright and vibrant fall morning here in Vancouver, my thoughts are focused on grief. A dear friend's mother died of mouth cancer two nights ago, I have been asked to speak to a group of family caregivers who have lost a loved one to ALS and I am rereading the transcript of a seminal keynote address given by Dr Alan D Wolfelt to the Association of Death Education and Counselling conference in Chicago in 1997 entitled, Companioning vs Treating: Beyond the Medical Model of Bereavement Caregiving.

These three occurrences have combined to return my thoughts to the early days of my own bereavement following the death of my husband and, 3 months later and quite unexpectedly, that of my mother.

During those days I was completely depleted, shell-shocked and bereft. Friends and family surrounded me with love and support but, as is often the case in our North American culture, that support gradually dwindled as time went on. Some, who didn't understand the the notion that grief takes as long as it takes, became impatient and frustrated with their inability to "fix" me. Others, who had walked the path of grief before me, waited patiently for the the cloud of sorrow to lift and stood again and again with hearts and arms wide open as, after periods of "improvement", that cloud of grief descended once more in the face of anniversaries, holidays or family celebrations.

Five things helped me through those months and years of sorrow:

1. The incidental comment of an acquaintance whose husband had died years before mine - "It will take 5 years before you know who you are without him". With this comment she gave me permission to take as long as I needed to grieve. The number of years wasn't important. It was the implicit expectation that my grief would take as long as it took. (For some, a long goodbye has already been said and soon after the death there is a sense of relief and an early readiness to engage with life again. For others, the road is longer.)

2. Moorings, the beautiful writings of Rabbi Vicki Hollander. Vicki had been my grief counsellor for a brief period during my husband's illness and, when she moved away to Arkansas and then to Texas, she left me with these poetic and practical reflections on what I might expect at different times during the first year and a half of my bereavement.

3. The Two of Us: My Life with John Thaw by British actress, Sheila Hancock. This autobiography / biography has been, rather surprisingly, a great source of comfort over the years. Interspersed between stories of her life with actor, John Thaw, (Morse, Kavanaugh QC, Mister Tom) are italicized selections from her journal telling the story of his cancer diagnosis, death and her early bereavement. Reading these segments was the most empathic experience of my bereavement and I will be forever grateful for the intuitive love and generosity of my husband's cousins who left a copy on the bookshelf in my sitting room during a visit to England in the Spring following Derrick's death.

4. The support of my spiritual director / grief counsellor whom I saw on a weekly then bi-weekly basis.

5. The support of family and friends who stayed in for the long haul, waiting until the sun shone again in my life.

What was the experience that linked these five supports? The experience of companioning. As Alan Wolfelt said in his keynote, companioning is different from "treating" or "fixing":

More specifically, for me ...

* Companioning is about honouring the spirit; it is not about focusing on the intellect.

* Companioning is about curiosity; it is not about expertise.

* Companioning is about learning from others; it is not about teaching them.

* Companioning is about walking alongside; it is not about leading.

* Companioning is about being still; it is not about frantic movement forward.

* Companioning is about discovering the gifts of sacred silence; it is not about filling every painful moment with words.

* Companioning is about listening with the heart; it is not about analyzing with the head.

* Companioning is about bearing witness to the struggles of others; it is not about directing those struggles.

* Companioning is about being present to another person's pain; it is not about taking away the pain.

* Companioning is about respecting disorder and confusion; it is not about imposing order and logic.

* Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.

If you would like to learn more about companioning and other aspects of grief recovery you can read more at Alan Wolfelt's Griefwords.

Thanksgiving in the East ...

If the only prayer you ever say in your entire life

is thank you, it will be enough.

Meister Eckhart

I'm off to Toronto in the early hours of Thursday morning to speak at the ATSS conference and then I will be driving down to Kingston to spend Thanksgiving with dear friends there.

I've been thinking about Thanksgiving and "gratitude" over the past week and was surprised to find an echo of my thoughts in an article in the Winter 2009 newsletter of the Callanish Society.

(Callanish is a wonderful nonprofit organization, worthy of your support, that provides retreats for people living with cancer and their families. A number of years ago my best friend, Linda Vick, attended one of their retreats before dying of lung cancer. It changed her life and touched many of us through her. I still have the journal she kept during her week's retreat - a treasured gift - and I read it from time to time when I need a reminder of what matters most in life.)

Janie Brown, Executive Director of Callinish, wrote these words in the Winter newsletter -

Many of us need to work at feeling grateful when life turns around on us.

A good friend of mine, Roger Hyodo, writes about thankfulness. He speaks about

two kinds of gratitude. The first is one that we cultivate based on our preferences,

beliefs, and values. We like something, we feel grateful. We don't like something,

we feel ungrateful. Our state of internal thankfulness is dependent on the ups and

downs of our lives. There are some people who tell us that we should see

everything as a gift, and that every experience that arrives is meant to be.

This is all very well, but what we cannot do is will ourselves to be grateful. It doesn't

work. All we do then is bypass our sadness, anger and regret, and send those feelings underground. At Callanish we offer a space for people with cancer to have their feelings, to honour the dark emotions by giving voice to them. In time, and it takes time,

I hear people speak not of cancer as a gift, but of life as a precious commodity.

Even in the midst of fiercely rejecting cancer, people can become clear that

there are things worthy of thanks.

The second form of gratitude Rodger speaks of is one that we may sense as a

"field" of thankfulness. I have experienced this many times in our circles at Callanish,

as well as in many other moments of my life. When we deliberately create certain conditions in our living, we become aware of this underling ever-present

quality of thankfulness.

Some of the conditions at Callanish are beauty, silence, real conversation, music,

art and spontaniety. We find ourselves risking expression to speak what is

true for us. In this kind of space, the heart seems to unabashedly open in response to

another's honesty, and we feel thankful. It feels like this thankfulness moves

effortlessly among us.

Perhaps, then, in these times of great uncertainty in our lives, it is up to all of us

to create these conditions for ourselves and each other ... whereby we can touch into

a genuine feeling of gratitude for the lives we are living.

When I hear someone express thanks amidst a life of great struggle, it humbles me to

look at my own life through a different lens. With that view, how could I not say,

"Thank you".

So, for Linda and Derrick and Barry and Mom and Dad and Christopher who, through times of great struggle, taught me about thankfulness, beauty, silence, real conversation, music, art, spontaneity, and mostly, love - I, too, say, "Thank you".