Tag: Resilience

Lessons From The Dying

IP

“You can look death right in the eye, tough as it is, and life lights up.” -Frank Ostaseki

My mom cautioned me not to write too much about death and dying in this blog. So, I felt I should clarify that I am not depressed, nor am I overly consumed by death. I remember the point in my residency when I really started to take note of the ways in which people approach death. It was at a point when I really needed something good to come from everything I witnessed that a preceptor encouraged me to write down three things I learned each day. I am sure this person meant what I learned about disease processes. However, I often wrote down what I learned about life. Luckily, nobody reviewed this notebook as part of my residency requirements! Within the pages of my “What I Learned Today” notebook, I started writing about what the dying said, how they acted, whether or not they accepted what was about to come. Through these observations, I have come to realize that death is a beautiful part of life, which is why a great number of my stories are about these patients and my interactions with them or members of their family.

I have been a part of more deaths than I can recount, so I realize that my comfort level might be higher than average. Often, how the patient spends their final moments can be a source of comfort. Take for example, my patient, who was telling jokes as he was dying. Steering the conversation in humor, as he had always done, was a great relief to his family. “He was ornery until the end,” they told me. There is also the patient who watched Maury until she could not any more. She watched and LOVED Maury for nearly 15 years and did not intend to stop before she needed to. The mundane eased her worry, a reminder that life would go on and as long as she was breathing she still had some control.

On the other hand, sometimes a patient spends their final moments in distress. We can try to mitigate the distress from disease processes. However, the emotional distress some patients feel often cannot be helped. One patient, through no fault of his own, had not seen his son in a number of years, and despite every attempt on our part to establish contact on behalf of the patient, we were not successful. The patient was distraught as he was passing because he was never able to reconnect with one whom he loved so much.

Most often, the way someone dies teaches me something. For example, from the patients above I learned that a sense of humor is key, one should do what they love until the end, and always maintain contact with cherished family and friends. These are life lessons I have usually heard along the way. Whatever the moral, these lessons imparted through observation certainly stick!

While some may believe these stories are not necessarily profound or breathtakingly beautiful in any way, I feel differently. I have realized that finding the goodness, and considering what is learned from the dying is probably the healthiest coping mechanism health care professionals can develop. I seek to honor my patients by speaking of them and gaining a better understanding myself. I desire to find beauty in and learn from my patient’s lives. I want to practice pharmacy in a way that integrates what is meaningful to me.

Strive for a beautiful life, that your dying might also be beautiful.

©2019 Inspired Pharmacist

Living Deliberately

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“Do not be afraid of death; be afraid of an unlived life.  You don’t have to live forever; you just have to live.” –Natalie Babitt

At least once a day, I am reminded of my own mortality, and it awakens me.  It has been almost three years since I met Ms. M*.  She came to us because she was becoming progressively short of breath.  She was nearly my age, newly married, and had just moved back to the area.  When I arrived that day, the physician alerted me to her presence.  She was very rapidly and mysteriously deteriorating, and would need to be placed on a ventilator very soon.  

When asked if a ventilator is what she would want, she was understandably scared.  I recall her telling the nurse she knew she was dying, but that she could not because she had too many things left to accomplish.  Almost immediately, and right after her husband stepped out of the room, her heart stopped beating.  Despite our best and most valiant resuscitation attempts, she did not survive.  She had an endearing personality, that all of us could see shining through despite her severity of illness.  

In the aftermath of ‘time of death,’ as I sat at my desk taking a mental break, I was once again confronted with the need to live deliberately instead of just passively filling my days.  In this case, the patient’s life so similarly resembled my life, and in my moment of pause, I could feel a ton of bricks set squarely on my shoulders.  It could have been me! The weight of it was profound and heartbreaking.  

It is uncomfortable to think about death in general, especially my own.  However, I have found that allowing myself to linger within the unpleasantness, if only for a moment, can be truly liberating.  For me, considering my last days also helps to reshape the present.

I often ask myself the following set of questions.  A spiritual mentor originally gave these questions to me; I have adapted them along my journey.  

If you were no longer here tomorrow, who would notice?  Further, what would they notice? Would they notice the absence of your kindness? Would they notice the somewhat mundane tasks you performed; daily acts of love now profoundly absent?  Do you have any regrets when you think about the answers to these questions?  If so, what can you do TODAY to change course.

If one is truly living, I believe the above questions can be answered with no misgivings.  To live, simply requires a search within for something more.  Bigger dreams, more passion for the things that occupy our time, the desire to continually learn and do better and the creation of memories with loved ones that will last long after death are required.   I certainly do not want my life to end until I have reached a wonderful old age, but witnessing death serves as a reminder that I am not the one who chooses. While I may not have a vote in how things turn out, everyday I wake up and plant my feet on the floor, I receive the opportunity to live deliberately and take control of the options available.

Moreover, one does not have to witness death to have a wake-up call that serves to increase motivation to take control and create change.  Use my lesson as your alarm.  Do what can be done today, no matter what else is happening, to create a life course that will not be viewed with retrospective regret.  Do it today before the choices run out.

“Tell me, what is it you plan to do with your one wild and precious life?”

The Summer Day by Mary Oliver

*Name changed for patient privacy.

©2019 Inspired Pharmacist

Who Heals The Healers?

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“A healer is not someone you go to for healing. A healer is someone who triggers within you the ability to heal yourself. ” -Unknown

“You up for a hug today, honey?” “Always,” I exclaimed. My favorite “lunch lady” was up to her usual tactics of cheering everyone she encountered, or at least trying. Sometimes, I long for her job. She is seemingly unburdened as she listens to everyone’s life story, pausing a moment here and there in the hustle of the day to really connect with coworkers and patient family members. I feel I sometimes do not have this luxury.

As I was preparing to write this week, I came across a staggering statistic from U.S. News and World Report. One-third of physicians report experiencing burnout at any given point. I know my blog is entitled Inspired Pharmacist, but one can imagine that these statistics at least somewhat translate across any profession involving high stress and high stakes. So, I went looking for the data. There it was, I found a similar rate reported among clinical pharmacists, especially those working primarily in critical care areas. I have not looked into contributing factors, but I can imagine burnout results in less empathy toward patients and increased feelings of being overwhelmed.

Consequently, I began to ask myself the question “who heals the healers?” Who are the ones who take the time to care about the ones caring for everyone else? Who are the ones who help restore empathy to health care professionals? Who are the ones who help restore depleted compassion?

The first person I thought of was the “lunch lady!” Many may not realize it, but she is part of the heart of the hospital. Whether she knows it or not, she carries a heavy burden. In fact, she carries a very important load, healing the healers. She, and others like her, are vital members of the patient care team. In a way, she mends the leaking wounds of other staff members and boosts morale as they go about their days. While I know and understand that a lot of healing comes from within, someone like her adds another layer of nearly impenetrable strength to our emotional armor.

We can all play a role in healing each other both emotionally, spiritually and mentally. When situations are viewed honestly and with a willingness to help, doors open and the healing process begins. In the course of healing, the one being healed and the healer both thrive.

While this lesson may be repetitive…be kind. Be the “lunch lady” to those you meet each day.

The 33 Things I Know To Be True After My 33rd Year!

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It’s my birthday week! I always become slightly more introspective around this time of year. So, this week, I thought I would describe the 33 things I know to be true after my 33rd year.

1. Everything can change in an instant and especially when it is unexpected. These are the defining moments that forever mark our lives. It is what divides the before and after in our life calendars.

2. Doing nothing is quite okay. Always being busy is a drug, and not the helpful kind. Trying to fill our days with “important” tasks often leads to burnout. Try doing nothing, and I mean absolutely nothing, and see how effective it can be.

3. Personal relationships are worth the effort, whether married or single.

4. Believe it or not, differences in opinion make the world better. However, one caveat, bizarre differences or those that effect the self-esteem or self-worth of others should be expressed with caution or eliminated.

5. Being grateful and regularly thinking about thankfulness increases happiness. My grandmother was right when she said, “be grateful for what you have and stop thinking about what you don’t have.”

6. One should never stop learning.

7. Likewise, one of the best feelings in the world is passing learned knowledge on to others.

8. If you REALLY want something, you have to work for it and figure out a way to make it happen. If you don’t get it the first time around, work harder. There’s an easy way to tell if someone truly wants something and it will seem so obvious after I say it, but it took me a long time to discover. It is this, those who really want something do not make excuses.

9. It is okay to say no. It is not rude despite the fact that I often perceived it that way in the past. No simply means that I know my worth and respect myself enough to stand up for what I believe in.

10. Early mornings are sacred. I am slowly becoming a morning person. I have found recently that early mornings are when I get the most things accomplished for myself.

11. Quiet time outdoors does wonders for the soul. There are no “influencers” there. Life can be seen in its truest form. So, sit on the front porch or deck, take a walk through the woods, or simply sit under a tree. The calmness is freeing.

12. Do not compare yourself to anyone else. My very wise mother once told me, “nobody is good at everything.” What I can do is the best I can and rest easy knowing I gave it my all.

13. We all have something we do BEST, try to find it! It does not necessarily mean you will be the greatest in the world at it, but it will give you something to lean on when tough times hit.

14. Be a planner!!!! Life becomes infinitely easier. Do not wing it and hope for the best.

15. Make the right decisions. Take the fear out of it. Ask yourself, will I regret not doing this in the next 5, 10, etc. years? If the answer is yes, then you have found the answer.

16. Coffee should always be iced. Cold water, cold beer, cold soda, why shouldn’t coffee also be?

17. Good cooking is easy if you have money, time and a recipe.

18. Some people are just mean. It has nothing to do with you and everything to do with them. “No one can make you feel inferior without your consent.” -Eleanor Roosevelt

19. Big dreams lead to big results. See #8 about really wanting something.

20. The best way to become something is to let someone in on your dream. Suddenly, the path becomes clearer and the vision more realistic. But, see #21.

21. Say it with me: “NOBODY IS RESPONSIBLE FOR ACHIEVING MY DREAMS, BUT ME!” Just because I let someone in on it, does not mean they should help to achieve it.

22. Always say hello and smile at everyone. Something so simple might just change a life.

23. Hope is worth so much more than gold. It is the only thing that makes difficult situations bearable.

24. Most of the time, complaining is gross. Figure out a way to change the situation if it is not acceptable.

25. Error on the side of quirky. There is value in “weirdness.” I am positive some of the best things in life were the result of a quirky idea.

26. Ask for forgiveness when a mistake is made.

27. I am not the first to say this, but find it to be exceptionally true…find three things you love: one that makes you money, one to keep you healthy, and one to keep you creative.

28. Humor is essential for happiness. The sound of laughter is more contagious than any sneeze. Laughter binds us together….enough said!

29. There is enough sunlight for everyone. So, cheer for those around you. Their success does not mean you have failed.

30. Success is NOT a straight line. Most successful people zig-zag or take a wrong path, or two. Keep going until you find the right one.

31. Experiences are infinitely better than stuff. They also provide better memories.

32. The “karma train” is real. All aboard!

33. No accomplishment or recognition can replace truly loving and accepting yourself.

Reach Out

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If you want to end your isolation, you must be honest about what you want at a core level and decide to go after it. – Martha Buck

Mrs. C* was 96 when I met her. She arrived to us from a nursing home after the staff called EMS for altered mental status. As soon as they walked out of the room, she yelled to the nurse, “I’m not really sick, I just had to get out of there, those people are driving me nuts.” Realizing it may be a while before someone from the nursing home could come get her, the nurses sat her in a chair at the nurse’s station near my desk. She said hello to everyone who walked by. To me, she seemed eccentric! She had bright pink hair, fiery red nails, and insisted on wearing a leopard print robe instead of a hospital issued gown. When I complimented her on her attire, she said, “What can I say, I just love beautiful things.” She spoke in such a way that it made me want to continue listening. All of the sudden, I started imagining she had been an actress in her life before the nursing home stay. Her theatrical skills, more than any illness had brought her to the hospital.

She told me about her children, how they lived far away, and about how the workers in the nursing home meant well, but often left her alone for hours at a time. She told me she felt so isolated from the world, and that this, her trip to the hospital, was the highlight of her month. It was interesting to me that surrounded by others, she could still feel isolated. She felt isolated because the deep relationships and companionship she so desperately desired were not present.

At some point after my interaction with Mrs. C, I read that isolation is more detrimental than some chronic diseases and increases the risk of mortality more than smoking. It is not just the elderly who are affected. It is also the poor, the bullied, the grieving, the people on the margins of society, and the rejected. Many people who are lonely and isolated, are too intimidated to speak up and form relationships even though that is what they ultimately desire. The most remarkable statistic…a heartbreaking statistic…25% of Americans have no meaningful social support. TWENTY-FIVE PERCENT without one single person they can confide in, the statistics are staggering.

I am sure there are a million and one things that contribute to this statistic – smart phones, long commutes, work hours, and distractions to name a few. Basically, life in the twenty-first century. After reading those statistics, it has become increasingly more important to me to help break the pattern. Why? Because personal relationships and a connectedness with others impacts human resilience. Personal relationships require communication, encouragement, reassurance and trust. Our personal relationships provide the security of knowing that others will be there when we need them, and likewise we will be there when they need us.

Many would have been irritated with Mrs. C’s constant interruption in their work schedule and the waste of resources she occupied during transport to and from the hospital. However, what I realized after my interaction with her was that her isolation WAS an emergency. So, I’ll leave you with this piece of advice. Work to fill up someone’s emotional cup this week. If you are feeling lonely or isolated, open yourself up to the love of the people in your life. Check on or get to know your neighbors. It may not be easy, neither will it be perfect, but perhaps in time the abyss will begin to fill. Be a healer…the cure could be as simple as conversation. Sometimes, medicine is not about medicine at all!

*Name and some patient information changed to protect the privacy of others

©2019 Inspired Pharmacist

https://doi.org/10.1177%2F000312240607100301

Hail Mary

IP

You can’t outwit fate by trying to stand on the sidelines and place little side bets about the outcome.  Either you wade in and risk everything to play the game, or you don’t play at all.  And if you don’t play, you can’t win. -Judith McNaught

Football season is in full swing around the Midwest.  I have spent many weekends recently on the sidelines watching the team my husband volunteers to coach.  Because I did not grow up watching football, and my high school did not have its own team, this has all been a learning experience.  I am slowly growing to appreciate the game. Notably, I am now critically evaluating how I believe the game could be better played and what penalties I would like to see enforced.  (I am frequently annoyed by the time outs at the end of the game! Illegal time out, anyone?) The play I now love to see incorporated in a game is better known as the “Hail Mary.”  Football is not really my thing, so I never gathered the true meaning of the term until a physician used it to describe the treatment plan for Mrs. C.*

 I had just received a call about her minutes before – “need you in the ER for a code.” When I walked into the room, the physician said, “she’s only 45, so I’m not going to call it, yet. What else can we do?”  I quickly went through my arsenal of ideas, slowly eliminating each one from my mental checklist of options, except for one.  “We could try this treatment,” I said.  “I’m thinking it will have a low probability of a good outcome, but based on what you are telling me, it makes sense to use it in this case.” The physician said, “it sounds like a Hail Mary, but we have to try.”  

 The physician was correct.  It was a Hail Mary play in the truest sense. A desperate measure to resolve a serious problem at the very last minute.  It was unlikely to be successful.  Truly, divine intervention would be needed for the treatment to succeed.  Therefore, I prepared the drug and hoped that against all odds it would work.  We had no other choice.  The treatment did not seem so risky when all other options were exhausted.

 When the nurse gave the medication, I prayed.  With every pulse check and every blip on the cardiac monitor, I prayed harder.  I kept my hand diligently on the femoral artery, anticipating that at any moment I would feel something other than my own pounding heartbeat. I prayed harder.

 As we left the room that day, the physician said, “Well, we did everything we could.”  He was right; we did it all, and then some.  It is at that exact moment when I realized that many times in our lives we are all faced with a decision of whether or not to take a risk. Not all of these risks are matters of life and death. Sometimes it is taking a new job, moving positions within the same organization, starting a new business, or just doing something outside your comfort zone.   Greatness requires risk.  Whether or not you are successful, the risk will stretch you and give you confidence in yourself and the faith to try again the next time.  

 I now understand why the “Hail Mary” pass is so important.  Whether or not the risk was worth it in the end does not matter.  What matters is leaving it all on the field.  You cannot expect to win if you give up.  Never leave the room thinking you could have given more.  

 

How will you identify the daily “Hail Mary” opportunities in your life?

 

 © 2019 Inspired Pharmacist

*Name and some details changed to protect the privacy of others.