Wanted to say a bit about …Power … The power of doing the next step…the power of increment.
Doing the next right step, even if small…, accumulates… and can change things in a big way… much like the way a small navigational correction early on a space mission could mean the difference between landing on the moon and missing it…

In providing comfort in healthcare, we see our hospice patients at the end of their lives, and frequently we are powerless to remove their pain… completely even with good meds.

Because some pain cannot be reached with medications… the unforgiven and unreconciled stories that THEY have lived …are many times… laid open before us at bedside…

It may even trigger some of our own human… and unreconciled stories that feel similar…which is normal.
Some pt have the fullness of a loving family, which they have grown … or by grace stumbled upon… or perhaps they have lived a life where we are the only people left to stand with them…

The IDG team has many capabilities … due to our inter-disciplinary professions, but we can only do so much… AND THERE is …a beautiful healing power is simply standing with them…no matter what. This is the POWER OF NOT-DOING… JUST BEING.

This ACCEPTANCE of “what is” , even when we cannot see beyond it… is key to comfort when facing down the Great Mystery at the end of life… ….

To summarize our IDG superpowers: …  knowing what is yours to do - even if a small step…,,, doing it, and,,, accepting the situation as it is …because it is beyond our ability to fix
There was a farmer whose prize donkey fell into a DRY well.  It was a deep well and it brayed and brayed calling for help.  The farmer was a fellow of modest means - he didn’t have a clue as to how to save the donkey.  He was sad but What COULD HE DO?

He decided that he could do something about the dangerous dry well…So he started with a shovel full of dirt, and kept up.  He invited his neighbors to help with any fill that they did not need.  Everyone had something, and little by little they filled up the well… and when it was complete, the donkey stepped out and went about her business.

That one step that we can do, that is ours to do,,, that one shovel full,  is always within OUR POWER …DO NOT doubt the power of that small step…… because it adds up, to great power…

ALL WE CAN DO - a 3 minute IDG Staff Reflection

In hospice and palliative care, we walk with our patients as they are… mid -loss. At the EOL, there are a lot of goodbyes.  That’s just he way it is.

We all, as a team, flavored with our different disciplines, to our best to offer comfort, kindness and love. We all approach it differently, but that is the work. To offer comfort, kindness and love into the losses.

But loss is a life long  process. We practice every day in the letting go of control… which we realize we don’t have… or don’t have much.
We - in our own ways- and in small steps - surrender to the Higher and the Mystery… each day. And if we are wise, we let go of what is NOT working… and do more of what is working in our lives… toward our needs for comfort, kindness and love.

We all do this.  It is all we can do because we are up against the early vicissitudes.

All we can do is cultivate, in ourselves and inner patients, a willingness to deepen into the losses and the mysteries that well up through the cracks in our lives… and we all have cracks in our human plans… from time to them.  It’s just the way it is.

Poem by William Stafford:  The Way It Is

There's a thread you follow.
It goes among things that change. But it doesn't change.
People wonder about what you are pursuing.
You have to explain about the thread.
But it is hard for others to see.
While you hold it you can't get lost
Tragedies happen; people get hurt
or die; and you suffer and get old.
Nothing you do can stop time's unfolding.
You don't ever let go of the thread.

Don’t let go of that thread; do more of what is working.
Blessings and thank you.

Click on the image above and the audio of the reflection will play...

In honor of Ramadan (and those IDG members that are hungry of body but not of spirit… ) I will begin with a quote from the Quran and end with one of my favorite Muslim poets: Hafiz.

I find that naming God in hospice … and in California is a improv.
Do I just call god, GOD?  It leaves out many who are wounded by religion…
And triggers others.

My favorite name for god is THE MAKER OF ALL THINGS.
It implies so much healing…in the name

That time, illness and death are on all part of a return journey to SOURCE.
It avoids thinking that Death is something broken… that we must FIX.

Our hospice team members in all our professions… provide comfort.  We do not fix.
I am sure you all have stories of providing care and them people blurt out things
That … under normal circumstances they would never say… or have never voiced..

We all have our unique medicines for these situations… to ease pain… but the biggest one in all
Our arsenals is listening.  Being a witness to pain and holding it in a way that
Shows them that they are not broken… just human beings… on a spiritual journey.

My week was full of that… reflecting back to several bereaved caregivers or widowers…
that they are not BROKEN.

They may have unfinished business that they can address, or not
…but it is all part of their journey,

I cannot force them… we cannot force them.

Hospice is about comfort.
Death is not a brokenness
No matter how it hurts, healing is possible… not fixing but healing.
We do it with good listening… yes.. and maybe good drugs too

But dont forget your UNIVERSAL superpower is listening with love and acceptance.
Being witness to their pain, and holding it gently
BUT NOT claiming it for your own.
Let it go.

Give it to the maker of all things.

To close here is Hafiz

Offered as part of an IDG Reflection Series by Garden of Change.org
Use freely, as inspiration for your IDT/IDG teams, or simply as self support. Attribution is appreciated.
Drop us a line and let us know how you do.  info@gardenofchang.org

IDG Reflection No. 13: NOTHING BROKEN

Well it’s spring... (at least in California...)
I can see it with my eyes... in the blooming of Bradford pears and the Purple plum trees... and the green green grass which has benefitted from so much rain.
But my body (and sinuses) are telling me, too.
Spring is about renewal, and planting more of what we want... but as in every life, we need to let go of that which is NOT working.

Yesterday was Ash Wednesday - the first day of ADVENT where we start to think about what renewal looks like for us. Maybe we give something up for the next 40 days... or Maybe we claim some new life-affirming habit.
But Renewal is in the air.

Like a garden, we can’t grow everything all at once. We have to weed...
What do I want to grow? What is mine to do? What’s working... and what is NOT working?
These are big Life and death questions for life as it happens...

Every human beings needs to find fresh new ground...To plant more of what is working.

Its true with us ... we need to address unfinished business - Unfinished business and unfinished relationships can have a serious negative impact on our live in the present day.

FOR those us of in Healthcare, our patients too - even when facing the EOL, need to address unfinished business... so they might be ready for whatever’s next - the great sleep, the Great Mystery...or the Maker of All Things.

These are the BIG EVERGREEN issues at EOL and just for a GOOD LIFE:

1. I Forgive you
2. I love you
3. I’m sorry and...
4. Thank you.
   

Happy Spring AND HAPPY Weeding.

Amen

Click here for a PDF Text of this offering - Use it as it works for your team. Or check out the YouTube Video.

Breath is medicine for better health, life and better patient care. This three  minute reflection sets the tone for your IDG meeting, to be thoughtful amid the secular pressures of EOL and palliative pain management, and that we, the healthcare staff and leadership, are part of the circle of care.  

It ends with a short Hafiz poem about breath and music.

For more on breath as stress reductions see this U of M. handout:
From https://www.uofmhealth.org/health-library/uz2255

Here is the second post of our IDG Staff Reflections Series for Healthcare Teams. It is in three formats for your free use: video, audio and text. Make it work for your own team, your offerings and your IDG team's unique culture.  Use them stand along or as inspiration to prepare your own.

They are free for your use. Drop us a line.  Let us know how it worked for you.

Best blessings,

Rev. Eleesabeth Hager

We as healthcare professionals cannot do our work if we ourselves are depleted. Best practices for employee retention, good care (and MCofP for staff care) are to regularly check in and remind each other about the circle of care in which we are all participating... until it is our turn in hospice.  Right?

The lessons of Winter are in the soil, which sleeps. It composts what is no longer useful. Let go of those ideas and notions that no longer serve is good gardening.

Here is a 3 1/2 minute audio for your IDG with a word document attached for your MSW, or chaplain or Adminstrator to read.

 More will be posted to keep us resilient now and in the new year – for ourselves and our patients.

​Yesterday I had this beautiful visit with a hospice patient and her adoring adult child who had been taking care for years and before that taking care of another ... also for years.

​This serial caregiver was exhausted, overwhelmed and moving toward burnout.

I got it...because I was it. She was on the tipping point into resentment from simply being willing. Our conversation eased her off the ledge because her feelings were reasonable and common ... but they were new to her. They were troubling because love isn't suppose to feel that way but overwhelm always feels that way.

Here is my patient's Happy Valentines Day 2022 gift to you today:

​May you be be surprised by the love...that loves you back. 

L.C. decided what his deathday would be a few weeks before it happened. It wasn’t mystical.

He quoted The Gambler song to me in his last days with us on hospice. In his cheerful, reserved but upbeat way, he smiled.

“You gotta know when to fold’ em…”

This brought to my mind an Orson Welles quote about happy endings. 

“If you want a happy ending, that depends, of course, on where you stop your story.”

Our hospice patient was a meat-and-potatoes, stand-up, guy because “my grandfather raised me that way.” In the manner he had lived his life, he chose that particular day because it was well-reasoned, measured and considerate of all concerned. As few humans in history have been willing or able, he was claiming for his departure the uncertain privilege of certainty: September 4, 2021 at 9 AM PDT. He had successfully secured the paperwork to a 21st Century legislated kindness: a prescription and promise for an end-of-life cocktail now available in eight states.
 
Denial that death might ever happen to us was a modern standard before COVID-19 happened. Only when death comes near, and to the dear, do we reconsider our own exodus as plausible or even just possible. Then we may contemplate the preparation of the mundane but mindful paperwork to guide our loved ones with our wishes. Who in human history has been willing or able to put a calendar date and time to our deathday, until now? Perhaps only a few enlightened meditation gurus’ who can reportedly transition on command, or the warrior-soldiers of history who have chosen to make the ‘today is a good day to die’ determination
 
Our good man was in another category – not of choice; he was condemned. Not for crimes, but with a prognosis. He was a prisoner none-the-less with an ugly and excruciating cancer death ahead.
 
Like physicians, he also had extensive and intimate trench-warfare experience with what cancer looks like on the frontlines of love and caregiving. As a young man, he had watched too many of his own family confront and fight this debilitating and disfiguring disease. He looked death in the face and it smiled back at him in his beloved grandfather, his own brother, his mother, and brother-in-law. He was their primary caregiver as they declined into his able arms and into well-meaning but painful attempts at end-of-life (EOL) medical fixes.
 
Physicians have a higher likelihood of choosing significantly fewer EOL medical interventions in the last six months of their lives than an average patient because they have seen the limitations and the downsides of the medical model, which is, itself, a miracle. We fix the broken parts of the human body so well and in so many ways that as Atul Gawande says in Being Mortal, ‘Death is no longer a cliff but a slide to fragility.’ Medical-aid-in-dying counters that iatrogenic miracle with its own.
 
As a master carpenter, our patient too, knew about fixing the broken and making it whole. He taught many young men from Colorado to California about learning the life skills of fixing the broken, being responsible and kind. He was a builder– not a destroyer. Our good man moved his life after caregiving to San Francisco where he, eventually fell in love with an old Victorian apartment house which he bought, tended and managed for the last few decades of his life. He knew when fixing was a lost cause and when it was worth a patient restoration.
 
The Death with Dignity Cocktail or as the legislators call it Medical Aid in Dying (M.A.I.D) is about knowing when to “fold’em’. It is not an easy decision. It is one that is best grown incrementally from the inner to the outer as other important life milestones. Patients commonly undergo many more painful procedures than they actually want to because they do it for their loved ones who are bargaining for more time–either with them or with the Maker of All Things. On the frontlines of love, the good decisions are the ones that families tend to make together, listening to their infirmed one and putting their needs above their own. It is messy work. It is the work that hospice is lovingly crafted to support with doctors, nurses, aides, social workers and spiritual care & bereavement providers, like me.
 
The medical model has many miracles to its credit, but how to have a good death is most certainly not one of them. Hospice can both support the dignity of control and the respite of surrender with as much comfort as is possible. We support the whole person within the family unit. We also stand in for that family when there are none available. It is a privilege that is more than a job. It is a calling. Hospice teams support, tend and comfort. We do not hasten death, but neither do we prolong it. Hospice does not kill.
 
With M.A.I.D., we now stand by, in support, as the patient drinks the cocktail unassisted, which is usually a legislative safeguard. This creates a new experience for the hospice team. We are all willing to stand and serve our patient’s choices but how we feel about it, personally, is still being sorted. For me, I have never read a eulogy to the person I was eulogizing. I did not know what to expect. I explained my intent, that his life was very inspiring to me with its balance of a teaching legacy as well as being a maker. I did not want to embarrass him, as he seemed a quiet, reserved fellow, but I was honestly moved to write something for his deathday. I let him know, there was no obligation.
 
Many people have commented in my eight years as a hospice chaplain that it was a sadness to them that the memorialized could not hear their own memorial. Our gentleman-carpenter was no exception to this. He was appreciative and touched that I had heard him during our conversations about his life. He spoke words from his heart and said, “There are very few people in life who really listen to you. They are thinking about something else, or how they will come back at you…but they don’t listen. I do want you to read it on Saturday.” And I did. (You may read it too at www.makingspace.com/ceremony/eulogy-for-a-m.a.i.d-patient
 
It begins and ends with a Native American Prayer – A Chinook Psalter
May all that we say
and all that we do be in harmony with thee,
God within me,
God beyond me…
Maker of the Trees.
 
L. C. met the Maker of Trees in the kind of death that most people say they want: in their sleep and in their own homes. It was for me perhaps the most gratifying death to which I have attended. It wasn’t just because his affairs were in order, the pain was controlled, and that he was ready, all which denote “a good death” but it was more than that. The Mystery from which we all come, reached out and called L.C. home, and because of M.A.I.D cocktail, he was able to reach back with the dignified control of a humble surrender. It was complete; it was a well-crafted finale.
 
 
Rev. Eleesabeth M. Hager is a hospice Interfaith chaplain in the San Francisco Bay Area, the author of two books, a resiliency workshop and a monthly, which is devoted to sustainable caregiving.