Final Transitions - Week 10

This posting may be a bit of a ramble – no one thing really caused me to focus on an idea or issue. This comes to mind: I've been a volunteer at the Whatcom Hospice House since its inaugural in September of 2010. 

I cannot say enough about the compassionate assistance the house provides during our final transitions. I've witnessed end of life in many of its various presentations; both in the transitioning person and in the involved families. Bereavement uncovers so many things, especially in the surrounding families; from unresolved family and personal affairs to celebration by extended families. Sometimes so many, they needed the conference room to eat the meals they self-catered in most days. Table settings were complete with wine glasses and expensive wines. The love and caring of those groups was palpable and can still moisten my eyes in reflection.

Juxtaposed were those families, whose members we needed to schedule the visits, because no one was on speaking terms. And sometimes in those situations, it was a best friend or neighbor who filled in as meaningful family. The gritty bitterness of unresolved family and personal issues hung over those rooms like a dark, moody shroud. One wondered at what point love evaporated like fog, kissed by morning’s light. And there were those whose health care provider’s pronouncement, “…life expectancy is less than six months” swung open the doors of hospice; and no one was there for them, except staff and volunteers. No one faces end of life alone at the house.

In the end, they all receive a little parting ritual; as the remains of the transitioned person leave the house and began the journey to their appointed place – three slow, soft rings from hand-held chimes meet tears and prayers, as staff and family line each side of the entrance lobby. After a moment of silence, the final physical journey begins; the spiritual, already complete.

All the topics covered in our materials this week exhibit themselves at the house; all stages of grief and grieving, stuffed emotions, heroic stoicism, peacemaking, letting go and not at all prepared. The single most important item I wish to leave you is your consideration and preparation for your own end of life events. Prepare your wishes now. Consider your own end, which may be close or far. Who can know?

It is so difficult for young and middle adults to comprehend themselves in a terminal state. The house hosted those from under 10 to over one hundred. The point is we just don’t know; so think about how you want to be cared for, what that will look like and who will make end of life decisions for you. And find the person who loves you enough to insist on them at your end of life. Record those wishes in a well thought out advance directive (I even have music picked to play in my room and flowers, but no lilies puhleeze), power of attorney for healthcare and a POLST. The persons whose affairs were so ordered were allowed the comfortable space for themselves and family to actually share the end of life journey and enter the grief process. Those unprepared – not so much!

And as I leave these postings, I am experiencing a mini-grieving process. Getting to know each of you and listening/sharing your heartfelt thoughts and feelings has been a meaningful journey. And now as we part, I mentally sound those three soft chimes that will send you off on the remaining paths in your the spans of life; wishing you peace in the fulfillment of your dreams, desires and nurturing relationships. It’s been a pleasure to journey a bit with each of you on those paths. Hugs from the heart, Rebekah. 

Ageing - Week 9

Connections to land;

Family, friends and culture.

Make/break span of life.

Lessons in Ageing - Week 9

Truth be told, I way more concerned about my first working shift starting this afternoon (even though it’s training), than I am about the excellence of this posting. So, let’s see where this goes.

One of the most interesting interviews of recent months was presented by a BBC reporter who traveled to the island of Icaria. Ikaria is a small island of the east coast of Greece in the Aegean Sea (http://bit.ly/16DEI19 ). Its name derives from the well-known tale of Daedalus and Icarus in Greek folk mythology. Icarus was his son who flew too close to the sun (not following the elder’s wisdom imparted before the flight; perhaps demonstrating immature prefrontal lobe development and the resulting lack of executive function J). The sun’s heat melted the wax holding his feather wings together and Icarus fell from the sky into his namesake, the Icarian Sea (it is a subdivision of the Aegean Sea, which is a subdivision of the Mediterranean Sea. http://bit.ly/16DEzL9).

The interview lead me to an excellent, expanded New York Times (NYT) article, by author Dan Buettner (Blue Zones, http://amzn.to/16DG6RF ) presenting a more complete and nuanced view of the longevity of the Icarian population. Between the BBC interview and NYT article several interesting features of the Icarian lifestyle emerged.

The leading figure of both accounts is a local named Stamatis Moraitis, an Icarian who emigrated to the U.S. A Greek WW2 veteran, married with 3 children, he was diagnosed with lung cancer in 1976 and given 9 months to live. Because funerals were cheaper on Icaria, he returned to Icaria to die. Quoting from the NYT article, “Moraitis and Elpiniki moved in with his elderly parents, into a tiny, whitewashed house on two acres of stepped vineyards near Evdilos, on the north side of Ikaria. At first, he spent his days in bed, as his mother and wife tended to him. He reconnected with his faith. On Sunday mornings, he hobbled up the hill to a tiny Greek Orthodox chapel where his grandfather once served as a priest. When his childhood friends discovered that he had moved back, they started showing up every afternoon. They’d talk for hours, an activity that invariably involved a bottle or two of locally produced wine. I might as well die happy, he thought.

In the ensuing months, something strange happened. He says he started to feel stronger. One day, feeling ambitious, he planted some vegetables in the garden. He didn’t expect to live to harvest them, but he enjoyed being in the sunshine, breathing the ocean air. Elpiniki could enjoy the fresh vegetables after he was gone.

Six months came and went. Moraitis didn’t die. Instead, he reaped his garden and, feeling emboldened, cleaned up the family vineyard as well. Easing himself into the island routine, he woke up when he felt like it, worked in the vineyards until midafternoon, made himself lunch and then took a long nap. In the evenings, he often walked to the local tavern, where he played dominoes past midnight. The years passed. His health continued to improve. He added a couple of rooms to his parents’ home so his children could visit. He built up the vineyard until it produced 400 gallons of wine a year. Today, three and a half decades later, he’s 97 years old — according to an official document he disputes; he says he’s 102 — and cancer-free". 

He never went through chemotherapy, took drugs or sought therapy of any sort. All he did was move home to Ikaria.” He simply resumed the island’s lifestyle and today at 97, is cancer free. He returned to the states several years ago to consult with his doctors, but they were all dead. So, what are the differences?

First, there’s no time pressure or stress. There are no clocks or wrist watches on the island, if one is to be found, it doesn’t work or is inaccurate. Scheduled appointments may be kept on either side of a 6 hour time window; no one minds, because that’s just the way it is. The local doc doesn’t open his office until 11a, because no one arrives earlier. Midday napping is endemic. Did I mention there’s no stress?

Note his reconnection to spirituality, mentioned by our text as an important facet of healthy ageing. And, the reconnection to extended family and friends; allowing for extended interactions which strengthen socialization and personal support mechanisms – both crucial in healthful ageing. People are not isolated with digital addictions, but rather are constantly going to each other’s homes and gathering at local cultural/religions functions. Social cognition is positive; replete with positive feelings and satisfying self-esteem.   Extended community: a proven additive to health and longevity.

Geography is notable in the island’s health promotion as it is mostly up and down, and that, fairly steep. Note that his vineyard and olive trees necessitated “stepped” farming techniques. That requires constant physical exertion to navigate anywhere on the island, and this is by foot; thereby adding constant movement and exercise in the daily routines. Life on the island is anything but sedentary; fitness centers would quickly be in bankruptcy.

Their diet is very much Mediterranean, including beans, fresh greens, fish and red meat only about 5 times a month. The local sourdough bread is well lubricated with home-pressed olive oils, hummus and wines. Honey is the staple sweetener, with varieties not found elsewhere; sugar – not so much! They consume many varieties of local teas produced from the local flora; and with the honey are also a part of the folk medicinal regimens. It seems they may have fewer free radicals and the shortening of their telomeres is certainly forestalled.

In juxtaposition is the island of Samos, a short distance away. From the NYT article, “Just 15 kilometers over there is a completely different world. There they are much more developed. There are high-rises and resorts and homes worth a million euros. In Samos, they care about money. Here, we don’t. For the many religious and cultural holidays, people pool their money and buy food and wine. If there is money left over, they give it to the poor. It’s not a ‘me’ place. It’s an ‘us’ place.” Such is life on Icaria.

There is so much more in the article, however it is clear older Icarians have well developed personal integrity with little despair (Erickson). There is little despair over the trajectory of one’s life on Icaria. It seems “retirement” is not known, but rather a continual readjustment of one’s activities based on functionality, but always useful. Are they creative? Well, the text defines it as “…the ability to produce work that is novel, high in demand and task appropriate”. The nonagenarians mentioned in the article remain extremely creative by that yardstick. Wisdom? You bet! Their life education and experiences are of a kind our culture is not familiar with, but obviously of a higher order, if quality and length of life are considerations. I don’t believe I read about any depression/anxiety/mental issues.

I could prattle on about the Icarians vis-à-vis our text, but I think you get the drift. I’ll close with an extended quote by Buettner in the NYT article, “During our time on Ikaria, my colleagues and I stayed at Thea Parikos’s guesthouse, the social hub of western Ikaria. Local women gathered in the dining room at midmorning to gossip over tea. Late at night, after the dinner rush, tables were pushed aside and the dining room became a dance floor, with people locking arms and kick-dancing to Greek music.

Parikos cooked the way her ancestors had for centuries, giving us a chance to consume the diet we were studying. For breakfast, she served local yogurt and honey from the 90-year-old beekeeper next door. For dinner, she walked out into the fields and returned with handfuls of weedlike greens, combined them with pumpkin and baked them into savory pies. My favorite was a dish made with black-eyed peas, tomatoes, fennel tops and garlic and finished with olive oil that we dubbed Ikarian stew.

Despite her consummately Ikarian air, Parikos was actually born in Detroit to an American father and an Ikarian mother. She had attended high school, worked as a real estate agent and married in the United States. After she and her husband had their first child, she felt a “genetic craving” for Ikaria. “I was not unhappy in America,” she said. “We had good friends, we went out to dinner on the weekends, I drove a Chevrolet. But I was always in a hurry.”

When she and her family moved to Ikaria and opened the guesthouse, everything changed. She stopped shopping for most groceries, instead planting a huge garden that provided most of their fruits and vegetables. She lost weight without trying to. I asked her if she thought her simple diet was going to make her family live longer. “Yes,” she said. “But we don’t think about it that way. It’s bigger than that.”

Worthy of reflection is the quote-closer – “It’s bigger than that”.

And that, is where this post went J G'day to all.

The Path - Week 8

Life’s path is curved;

Arcing across one’s lifespan.

No sight past the bend.

Crisis? What crisis! I've got wisdom. Week 8

Never had one! The crisis anticipation factor was definitely aroused by all my friends and family, but nothing of note ever actually transpired. There was a little episode of Porsche desire, but it came and went so quickly it barely made consciousness. It took but a moment’s reflection to conclude “…just what in the world would you do with that? There isn't a road built around here you could drive that in the way it was designed to be driven…”

Truth be told, my life proceeded along such full and interesting paths, I honestly had little time to reflect on whether I was facing a crisis of age or accomplishment. That is not to say things were always easy and crystal clear on this path; they were not; often it was more a crisis per day. But the path was always interesting, engaging and fulfilling.

There were often moments of wondering just where my life was headed, but it seems things pretty much took care of themselves, as long as I paid attention, worked diligently in the moment and listened to my intuition – a knack that was slow to develop. Doors closed and doors opened; often requiring courage and sacrifice to step forward. In retrospect, I’m pleased that I took those steps.

For many years there was an underlying current of fear; the fear of winding up on the street, homeless, penniless – an abject failure.  A fear that was rooted in an authoritarian upbringing so structured there were few decisions I was allowed to make. Tack onto that the oft heard pejorative “…you’ll never amount to anything…” Add into the sauce of my childhood, the parental ingredients of depression era kids in want and need; and their own childhood woo – woo made its secretive way into my subconscious. Took some time to understand myself in light of all that and I’m grateful for the degree of enlightenment to date. And, well, there was that another thing. So it seems there really wasn't a great deal of time to have a crisis; perhaps one day I’ll understand that it was a drawn-out string of crises; but I don’t believe that will be the case. 

I find agreement with Kessler’s perspective when he states, “…all people make psychological transitions and adjustments in the course of middle age; relatively few experience these as catastrophic.” As he states, my experience also includes divorce, being fired, and serious illness – and the awareness my birth year was becoming a part of my very distant past. My appreciation concerning all the turmoil, trouble, achievement and joys, was the understanding these events and vicissitudes were all a part of “normal” life experience – and it was my path alone and not comparable to the paths of others or theirs to mine.

So midlife crisis? Meh – not so much.

Gallagher’s closer regarding the onset of wisdom I found to be spot on. One may occasionally considers the prospect of “going back” in life and re-doing certain parts. ‘Prolly not; the premise is one will take along the accrued wisdom and apply patches to past situations. The premise is of course faulty, for I would be just as ignorant as I was the first time around.

I wouldn't trade where I am now for all the chances in the world to rewind for a re – do. I definitely find myself aligning with the “environment – minded” researchers who believe the influence of attitudes, interests and relationships provide a flexible model of adult development. Reflecting on my experiences, it is clear they strongly point to development and change that continually refocuses my understanding and perspectives of life and the world around me.

Baltes is correct in his assertion that the brain slows down biologically, as I can attest. But, I do use knowledge and information differently and more effectively. Exactly how these adaptive strategies operate, I cannot fathom; I unconsciously somehow rapidly apply experience and knowledge as situations unfold. And the outcomes often reflect that I am still learning.

I’ll close with an anecdote that illustrates the discussion of wisdom. My closest brother was a “back-seater” in an F-4 Phantom fighter jet. His title was Weapons System Office or WSO – pronounced wizzo. Or in their vernacular “GIB” – the guy in back. He flew in the Air National Guard, which has pilots typically much older who still fly. During combat fighter maneuvering, the crews experience punishing g-forces.  The older crews are not physically capable of keeping up with the maneuvering of the younger pilots. However, the older pilots will typically out maneuver their younger counterparts because they fly smarter – with the wisdom of lessons learned.

Sunshine & Shadows - Week 7

Love blooms feeling good;

Secreted darkness creeps out,

Breaking cherished bonds.

Split or Stay - Week 7

I was particularly intrigued by the Kirn article “Should You Stay Together for the Kids”. My thought processes were pretty much like a ping pong game. Back and forth regarding Ms. Wallerstein’s postulates, which based on personal experience, I tend to support; or at least tend to want to support.

Here’s why. I was raised in a small rural Minnesota town. My dad was a very successful dentist and my mom a very successful mother and housekeeper. But there were deep seated issues between the two of them mostly over my father’s ongoing infidelity. Mom even served him papers once, but he bought her off for $10k. Such a deal! They did stick together and were civil in the process, even to the extent of the occasional hug and peck.  Which, at some level, speaks of love not quite lost. Or thespians!

Why did my dad hang on? As a locally well-known professional, he was of the generation that counted “appearance” to others as most important. He would have been the talk and gossip of the town if a divorce occurred; and I don’t believe he could countenance having his personal life in the public square (not that he’s affairs were a secret).  I don’t believe his ego (which was considerable) may’ve survived. So he stuck it out. Pride can crowd you into some interesting corners!

For my mom: she was a high school grad whose highest occupation had been selling tickets at the local bijou – the precipitating cause of their meeting and eventual marriage. She had no skills in an era when most women were in charge of the household and there was simply no employment market for her to enter. Besides, she knew want first hand, as a depression kid. Her dad was a vet, but times were so tough, she and her brother walked the railroad tracks to pick up coal that fell off the trains. So she stuck it out. The fear of want can crowd you into some interesting corners!

I cannot calculate the emotional impacts to my parents. My mother would pick her fingers raw and was a compulsive spender; things the analyst’s couch never divined. My dad suffered a nasty peptic ulcer, which was a several week, bi-annual, eggshells and tiptoe time. Counseling was for psychos.

And for the sibling group of three: my brother and I are eighteen months apart – I lead in age. We were aware of the tensions, but there was never any overt hostility displayed and it sorta felt ok, even though we knew at some level it wasn’t. The loss of nurturing and socialization did impact all of us in our early and middle adulthoods – a story for some other time. The youngest brother trailed us by almost ten years and I think felt the insecurities the most; perhaps evidenced by his enuresis until age fourteen.  The upside is we always felt truly like a family. Meals were always together, conversations were about current events, mini lessons in civics and things intellectually stimulating. There was structure, routine and responsibilities to attend – lifelong building blocks.

So, I appreciate Wallenstein’s position; because I believe our sibling group was/is much better off for our parents making the best of it. I know my mom would often say we kids were the only reason she stayed on. But as we’ve discussed recently in class, the cultural socialization of our society has undergone dramatic shifts in the few decades since my childhood. And that socialization/cultural norms shift has pretty well minimized/erased those older concepts/reasons for staying together. This I believe makes it almost impossible for couples with marital dissonance to consider alternatives to divorce. True, there are those that seek counseling and do manage a reconciliation of the dissonance; but for many, the statistics suggest otherwise. 

And I further believe the lack of dual parental nurture, love and socialization is woefully inadequate in single parent households for the reasons amply stated in Kirn’s article.

Here are a couple of vignettes from a long time ago and a land far, far away. It is tale of two couples. Once upon a time, I was an apartment manager in the Chicago area. And in this complex were forty units. And living in this complex were two Indian couples from the sub-continent of south Asia. As I wandered the halls and did my manager things, the presence of curry always announced the approach to their apartments.  But aside from the similarity of the curry the two couples presented diametrically in deportment.

The one couple could be frequently heard involved in VERY loud arguments and sometimes other not so reassuring sounds.  I was sometimes called by neighbors to quiet things a bit. Even though a sense of anger was usually about them, they were always polite, he definitely in control, she dutifully in position three steps to his rear. Their abode was usually not picked-up, neat and tidy. The other couple was quiet as mice, always pleasant, both chatting with me in a friendly and amiable manner. The place was always just comfortably right; and always some little Indian snack was forthcoming.

After some time, I learned through conversations with each couple a little more about them. It turned out that the argumentative couple had “fallen in love” and left against their families wishes and came to the states. It always felt unsettled, tense and like things were not so good. I don’t believe they lived happily ever after.

The other couple was in an arranged marriage, put together by their respective parents at a very early age. I conversed with them several times about this and what their feelings were at the beginning of the marriage and how were things now? At first they were just timid and shy with each other and performed pretty much to cultural role expectations. But as time went on, they became deeply appreciative and affectionate of the other; until one day – voilà they were deeply in love with each other. And it was obvious, just being in their presence. They said they just simply grew to love each other over time and that it grew out respect and consideration for the other. I fully believe they lived happily ever after.

There’s a moral or two here; I’ll allow you, gentle reader, the opportunity to parse them.