I stepped from Plank to Plank
A slow and cautious way
The Stars about my Head I felt
About my feet the Sea.

I knew not but the next
Would be my final inch -
This gave me that precarious Gait
Some call Experience.

Emily Dickinson, c. 1864

Sunday, November 22, 2015

Thanksgiving week is here

Last Thursday's waterfall
Do you think of your week as starting on Sunday or on Monday? I pondered that question as I thought of the title for this post. I myself think of Sundays as the day that can easily belong to either end of the seven-day cycle. This coming Thursday will be Thanksgiving in the United States, and people are on the move. I am always amazed when I read about the huge numbers of people who travel during the holidays: this year, almost 47 million Americans will drive, fly, or take trains to another part of the country.

For many years after my dad died, I would travel to Texas or Oklahoma to visit my mother for Thanksgiving. When she died in 1993, I would travel to be with other family members who live in the area. I always stay with my brother and his wife when I visit, but lately my choice of family to visit are my sister and her family who live in Florida, as you know. I purposely traveled before the holidays to avoid the crowds, and boy am I glad I went when I did. I'm sure airline travel will be much more stressful, not just with the crowds, but also because of current terrorist events such as Paris, the airline bombing, Beirut, and Mali. My dear friend Vagabonde has written a wonderful post that says it all so much better than I ever could. She is a Frenchwoman who came to this country many years ago with her American husband. I've followed her long enough that she feels like a true friend. She has taught me so much about the history of France and much, much more. In that post she introduced me to a Latin phrase that has been a motto of France since the 16th century: Fluctuat nec mergitur, which translates as "tossed but not sunk."

Last week I had my introductory interview to decide whether or not to pursue the training to help others fill out their Advance Care Directive forms for end-of-life choices. I've decided to go ahead and do it and have agreed to give a few hours every month to that effort, once I'm done with the training. As I've learned, it's time to begin thinking about these things now, today, no matter how old or vigorous you are. Check out this website and Begin the Conversation. Here's a wonderful quote from that website:
End of life care planning requires filling out appropriate advance care documents, but conversation about these documents is key. Those chosen to carry out your end of life care wishes must know what you want. Documenting your end of life care wishes and telling others is a gift.
I also attended a presentation that was held in a packed room about the realities of advanced medical interventions. Two critical care ICU nurses, Cathy and Koala, decided it was an important thing to let people know. A year ago they held what they thought would be a one-time presentation. But the demand was so huge that they have held 19 more this year, and will continue for as long as there is interest. Some people have attended their presentations more than once, and I will probably be one of them. It was enlightening to find out what exactly happens in the Intensive Care Unit if you are admitted there. Scary, too.

It brought back to me in vivid detail the difference between the deaths of my father and my mother. Daddy had a massive heart attack while walking into the hospital. He collapsed in the entrance after having been driven there by Mama. A few days later, all six of his adult children had traveled from wherever we lived to Fort Worth, Texas, where he lay in a hospital bed. As I remember, when I saw him he was propped up with pillows and not laying down, but I first noticed how the pupils of his eyes were just little pinpricks. That was caused by the morphine he was being given. Otherwise he seemed like himself, but he didn't mince words and let us know this was the end by using phrases like, "I'm glad you got here before I popped off." He knew. He lived three days after the attack.

But back then there were no advance directives, and he was placed on a respirator, even though there was little to no chance that he would survive. I still get chills when I remember that experience, and now I know why. If I could go back and do it all over again, I'd make sure Daddy knew he didn't need to do it. If I can save even one patient from useless end-of-life measures, it will be worth my time.

What Cathy and Koala showed us was what the equipment looks like, how it is used, and why, and what the chances are of someone actually recovering enough quality of life to even be sent home, whether or not they are able to return to a normal life. It's a very small percentage, and the older we get, the smaller it gets. I'm talking single digits here. We saw a film that showed a man who was actually having a heart attack, and how he was resuscitated with CPR and electric shocks. He recovered, because he had two professionals who knew what they were doing right there with him when it began. He was very lucky.

Mama, on the other hand, had a severe heart attack and was able to return home and go onto Hospice, where she had a doctor and a nurse who made daily visits. She was given palliative care, made comfortable and able to stay at home. My sister Markee is a registered nurse, and she was able to leave her job and come to stay with Mama for a few weeks. We were all able to visit her and be with her in a quality way before she finally died. She was never put on any machines. She went into a coma a week before she died. I was with her when she took her last breath, and it was a peaceful experience for all of us who were present.

Death is a part of life that we don't like to think about, but it comes to us all. And today we all have the opportunity to decide how much we want our medical professionals to do to us to give us a chance to keep on living. And what that living actually looks like from an ICU bed. I've got my advance directive forms on file at the hospital, my partner knows what I want and I know what he wants. My sister Norma Jean laughingly said, "you mean I get to pull the plug?" when I asked her to be my secondary person.

It's amazing how empowering it is to take a hard look at one's end-of-life choices and actually make them. I know this isn't a normal Thanksgiving post, but frankly, I cannot tell you how thankful I am that I and my loved ones have options. I won't be kept alive when all I want to do is slip away gently, like my mother did. It takes some courage to think about these things, but it's truly a gift to your loved ones.

So I give thanks this week for my current health and vitality, knowing that it won't always be this way, but until then, I'm going to enjoy myself. I'll happily prepare a Thanksgiving meal here at home and enjoy every morsel. And I am also wishing you, my dear readers, will enjoy your week until we meet again, and wishing that you stay healthy and happy, too.


Far Side of Fifty said...

The Advanced Care Directives are very important! We have ours and I am glad we do. It is much better for the family...much better.
This week I am thankful for the clean snow that covers the ground because it will insulate our septic system and our water lines...so we can still poop and drink water. I am thankful for a loving husband and a wonderful dog to share my days with. I am also thankful for blogging friends like you who let me into their world and their thoughts:)

Linda Reeder said...

I read most of Vagabonde's post, and it is wonderful. I have just had another Facebook encounter with my brother, which has upset me, and I had lunch with retired teacher friends on Wednesday that upset me too. The fear, hatred, fear mongering and ignorance displayed just overwhelms me sometimes.
We have end of life directives, but we should go over them again and see if they are as complete as we would like them. We have not discussed them with our children yet.
Despite the evil in our world, there is much good, and beauty, and plenty to be grateful for this Thanksgiving. My grandchildren will fly away to Colorado, but our two "kids" will join us as we travel south via the freeway to join extended family. It won't be perfect, but it will be good.

Red said...

Well, that was a sneaky way to get to the Thanksgiving topic. Have a great Thanksgiving weekend. I think you are right about end of life care. However, the end of each life is different. It's not always an easy call as to treatment. Here nursing facilities sometimes get in the way and order life saving( life prolonging) measures.

Anonymous said...

Yeah, I intend to enjoy the rest of my life, too. It might be shorter than you think.

Nancy/BLissed-Out Grandma said...

Thanks for another reminder about advanced care directives. We have blank forms and we've talked about our choices but we still need to commit them to paper. Have a great Thanksgiving Week...you are clearly in a very good place in your life!

Elephant's Child said...

Intensive care is indeed a scary place. I am so glad that I was able to let my mother slip away. And that my father was well enough to say 'no heroics', and that he too slipped away.
My partner (bless him and drat him) refuses to consider such issues. Or make a will.
Your thankfullness is a huge part of who you are. And thank you for that. Hugs.

The Furry Gnome said...

Along with advanced care, i think there should be some effort to have everyone put on file an information form providing critical info to surviving relatives - stuff like banking info, passwords (cause so much is done online now), life insurance info, investments, etc. having the basic info at hand makes it SO much easier for those left behind to cope.

Rita said...

The week starts on Monday for me.
I totally agree that you need to let your family know what you want and don't want. Especially these days when they can do so much that is unnecessary. And it needs to be in writing also. Still sometimes the medical community ignores your wishes. It's a good thing to be prepared. :) Happy Thanksgiving!!

Linda Myers said...

We have end of life directives. I feel relieved to know that I will not need to be confined to an ICU or a nursing home.

Sounds like a fascinating, rewarding way to volunteer!

John's Island said...

Hi DJan, My own story of how my parents passed is very similar to yours. My dad had heart disease and ultimately, at 84, he died while in the hospital but not before being kept alive for several days with special drugs and equipment. It was such a tough time for the family but we all knew he didn’t want to live like that. Mom always told me she wanted to die in her sleep but at 91 she fell and the resulting hip injury was her demise. You are very kind to take on helping people during these tough end-of-life times. Another excellent post here. Happy Thanksgiving to you and Smart Guy and have a great week ahead.

C-ingspots said...

Maybe not what we'd think of as a regular Thanksgiving post, but beautiful all the same. Your list of blessings are both important, and lovely. Peace of mind comes in many forms. Hope your Thanksgiving is thoughtful and enjoyable.

p.s. For me, Saturday is the Sabbath and closes out my week. I'm always thankful for it too...

Dee said...

Dear DJan, thank you for this posting. I'm grateful for it. Back in January I planned to get a will done this year as well as a living will--getting ready for the end of my life. Neither was accomplished and so this coming year I hope to do so. I did ask my niece to be an executor for me and to be the one who sees that my directive is followed, but that's as far as it got. So your posting is timely for me. I don't want my family to have to make these difficult decisions. That's too much of a burden to place on them. So I must make them. I'll go to the website you suggested and get started. I'll also talk with my niece and my brother and sister-in-law to be sure that they understand my decisions. What a lovely thanksgiving gift you have given me. Thank you. Peace.

Marie Smith said...

I am so glad to have found your blog. I love your thoughts on End of Life, opening for discussion the last frontier we each must face. Beautifully written. I will be back.