Obligation

           Obligation is the singular word that motivated me to do many things throughout my life. I have always felt a heavy responsibility to “do the right thing” and what that meant varied, but generally there was a decision tree that started with family and had no room for individuality. If my family expected me to be present at various events, showers, weddings, birthdays or BBQs, I attended. Not because I really wanted to go to all these things, but I felt I had to go. It was expected.

My girlfriend and I were just talking about her invitation to an upcoming baby shower, where she has no interest in going because she has been working through infertility health issues. She doesn’t feel up for it, but feels obligated to do what the family expects she should do. She says she is a “pleaser”, as am I, so I understand the desire not to disappoint people, and to make the effort to do what is expected. My fear of disappointing others is another deep motivator, and when that is paired with obligation, I do whatever needs to be done.

                I did not become a Caregiver out of a sense of obligation per se. I was only the grandchild, and as my cousin reminds me, I “disrupted the pecking order” in that Gramps’ had two grown daughters that really should’ve been responsible for his care and the decisions around his care. I definitely felt a responsibility to my family, and that is always present. However, specifically, I didn’t take care of Gramps out of obligation, as much as feeling a responsibility to stand by my grandfather and help him because I loved him. He was very dear to me and my grandparents always loved and supported me. Loyalty and love guided my decision to be a Caregiver.

                The difference between doing something out of obligation v. loyalty and love is the self-check to determine if you want to do the task at hand. If you really do not want to do it, and you are going to do it anyway, that is doing it out of obligation. If you want to help, even though you don’t know what you are getting yourself into, that is loyalty and love for the person. I do believe that obligation has its place, because I think without a sense of obligation, I fear it is human nature to take the easy way out of things, and that would not be good for anyone. There were times where Caregiving was overwhelming, but I still did it, and that is another aspect – commitment. Once you’re in it, you’re in it.

                I am reminded of a story about Jackie Kennedy immediately following the assassination of her husband, when it came time to swear in Lyndon B. Johnson. LBJ wouldn’t leave without Jackie, and she wouldn’t leave Dallas without her husband’s body, so they waited and then did the swearing-in on the plane. Jackie took her place next to LBJ in that famous photo, and she was quoted as saying she knew she had to do it because of her role, as First Lady, and it was important “for history.” A good example of where obligation meets love and loyalty of country.

                Doing something out of obligation isn’t always a bad thing, but you can’t do it all the time. You have to be honest with yourself and evaluate what it is you need and want, and then decide what to do. You don’t have to say “yes” to doing something. “Doing the right thing” sometimes means doing right by yourself too.

Simple-minded

              There’s something to be said for the KISS method, to Keep It Super Simple. Caregiving is complicated. Healthcare, Insurance, Medicare, Veterans Administration, Medication Management, and the list goes on. When it comes to relationships with loved ones and friends, we appreciate simplicity. When it comes to those rare downtime moments, we gravitate towards get-togethers that require low level of effort. There’s something eloquent in the easy. I am not sure where the term “simple” got a bad wrap?  Simple-minded is not a bad thing in my book. Life has all sorts of intricacies, and if you can find a way to streamline and simplify, all the better.

                After my Gramps passed, I got back on the road, travelling for work, but my first long weekend I went to New Orleans, the “Big Easy.” I always loved it there and hadn’t been in years. Any city that celebrates spirits, cocktails, food, and jazz is alright in my book. I just love saying “Big Easy.” What in life is ever easy? It’s rare, isn’t it?

                So this Saturday, I am Simple-Minded, and trying to make my life one Big Easy. I have a little bit of a cold today, so I went for a walk and got some fresh cold-pressed juice, an apple-lemon-mint-fennel concoction I made up, and a side shot of ginger. I believe ginger can cure anything! After my walk go get some sunshine and Vitamin D, I came home, read and caught a NCIS marathon. I did some online shopping on Amazon for a few books, and I am becoming a fan more and more of online shopping and recommend it for those items you don’t feel like running to 10 different stores to find. Easssyyyyy day. Nowhere I needed to be, run to, get done. Simple. Saturday. Have a wonderful weekend!

Carrot and Stick Healthcare

                Let’s talk about healthcare reform and “attainment incentives.” There already are some of these attainment incentives in benefit packages today, the most common are employee wellness programs that set standards based on things like Body Mass Index (BMI) and cholesterol levels. The thought being if you keep yourself in good shape, eat right, exercise, do your routine screenings, you will be healthy and therefore deserve a discount on your healthcare premiums, because you will consume less healthcare services, saving money to employers and the overall system. I think the issue I take with all of this goes back to my Dad, who was morbidly obese and tried every diet known to man. He would never be eligible for such rewards, not because he didn’t try, but because he couldn’t achieve the goals and standards. These programs make no distinction between trying v. not trying because they both equate to a “fail” and disqualification from getting the reward. The carrot to develop healthier habits is actually a stick, punishing those who need help the most.

People who advocate these programs say that it places responsibility on the individual where it belongs, much like auto insurance has good driver discounts. I don’t think that is a fair comparison. If only quitting smoking and losing weight were as simple as driving the speed-limit. There are people who think obese people are fat because they are gluttonous pigs who indulge too much and are lazy (and believe me it pained me to write that, but it is true). These provisions follow that thinking, that if you are overweight and/or have bad cholesterol, it’s your own fault, because if you made the effort, you would be healthy. It’s just not so.

Further, people who are all-for-this argue that these wellness plans are “voluntary” and employees do not have to enroll in them. Here’s the issue there, low income people need these incentives to make healthcare more affordable, so they have to enroll, but these are the very people that cannot afford a gym and tend to gravitate towards fast food and unhealthy choices. These incentive plans benefit the wealthy and healthy.

I think there is room in healthcare reform for attainment incentives, but there have to be levels and standards to allow for the lower income people who need assistance in meeting the rising costs of healthcare, and to also allow for the people who need the healthcare services the most.

Healthy Choices

              My Dad was morbidly obese and died of a heart attack. It was terrible. My whole life I was afraid my Dad would die, particularly, because he was so overweight. Obesity is a thief that hides in plain sight, stealing life away of its victims. My Dad tried every diet possible, but nothing stuck. I used to try everything to get him to eat healthier. Finding him having a heart attack, attempting CPR, the ambulance, all of it was so traumatic, I suffered from flashbacks for months and was diagnosed with PTSD. To this day, I hate the sound of ambulances. I also get upset easily by fat jokes or thoughtless comments people make about overweight people.

                My own weight dived dangerously low as a Caregiver, and it’s ironic because I was eating toasted pound cake for breakfast and some really odd, unhealthy meals based on what my Gramps wanted to eat. So my first experience with weight issues was rapid weight loss due to stress. I felt like my body was out of control and I really thought I was going to waste away, and die, and there was nothing that anyone could do about it. Now, I found myself a little overweight and working out with a trainer 3x per week to try to lose weight – it’s hard! My how the pendulum swings!

                I think the best healthy eating advice I ever heard can be summed up quite simply as this: Don't eat the food (unless it's "whole food")! Focus on ingredients not food. Buy ingredients to make your meals at home. When you go to the store, shop the outer aisles of the supermarket where the produce, daily, and deli sections are located. Avoid the center aisles where packaged “foods” like cookies and cakes are located. Who would’ve thought “food” would be a dirty word? It is when it comes to eating healthy. There’s fast food, frozen food (fruit is okay), packaged food, processed food, and the list goes on. Basically anything that has “food” in the title on a box is not healthy for you to be eating, and whole food is the only acceptable food to eat.

                Make good health your priority for you and your loved one. Caregivers must stay strong, physically, mentally and emotionally. Be good to yourself and make healthy choices!

The Cane

              My Gramps was an electrician and was always handy around the house. His friends and family always called on him to fix or install something. This was all prior to his stroke and when he was in good health. After the stroke he was in a wheelchair with limited mobility and relied on this cane to transition to the toilet. I have to tell you about his cane because it’s truly unique, and it offers some good insight to my Gramps. My Gramps took an ordinary cane tripod and made it something extraordinary.

                My Gramps always had an active mind and was always looking around to find something to get his hands on to do. His mind was always going! One day, he decided he needed a basket for his cane. So, we fastened a basket to the front of the cane, almost like one would secure a basket on the front of a bike. In the basket, he kept a small, square box of tissues – it fit perfectly. He always needed tickets and he tucked them everywhere! Pants pockets, jacket pockets, underneath his pillow, by his favorite chair- quite literally there were tissues all over the house! Mucinex and nose drops helped a lot, but still, the need for tissues and the basket in the cane was useful, but there was more needed…where to put the used tissues?

                One day we had some potato salad from the deli and it came in a big plastic container. I washed it out, and Gramps had me fasten a container to the front of the cane, putting a smaller container inside. The outside container became the holder for the “garbage container” in the middle. I must’ve dumped that thing out a hundred times a day! It was perfect for used tissues. Now my Gramps had a super-cane! I was proud of his ingenuity and how these simple things made his world a little easier and made him feel even more self-sufficient.

                When my Gramps passed away, I kept the cane. I felt like it represented so much that was good with Gramps, his active mind, ingenuity, and his striving to be self-sufficient, even with his limitations. I kept the cane a long time, than finally decided to take a picture, and donate it, so it could go on to help others. The cane was part of our everyday routines. I have so many memories, putting new tissue boxes in the basket every other day, throwing out the garbage from the lower basket throughout the day, helping Gramps transfer to the toilet and even to his favorite chair for watching t.v. It was important to me, so it was the thing I kept when he passed. Ever notice that the closer you are to the person, the lower the monetary value of the thing you keep in their memory when they pass? I think about the cane when I feel limited and it inspires me to move forward. It is what my Gramps would always do and what he would want for me now.

Bad Mood, Bad Words, Bad Move

                Today I had the displeasure of letting staff (albeit consultants) know they were being let go – never fun. I think I did a decent job considering the circumstances and I was very careful with my words, but it got me thinking about what happens outside of work, when we are having a bad day, and bad choice of words just slip. I can sum it up as a Bad Mood + Bad Words = Bad Move.

                Caregivers have many bad days and it’s easy to fall into a bad mood. It takes effort to stay positive, focus on the good, and maintain an attitude of gratitude. No matter how bad our mood gets, there can never be an excuse for poor choice of words and being hurtful to someone we love. Bad Moods pass, but you know, once you say the Bad Words they cannot be taken back.  By “Bad Words” I am not referring to expletives or “cuss words”, although they qualify! I mean words that hurt someone else’s feelings.

                I got along well with my Gramps and his doctors and aides, so my version of “Bad Mood” was mostly depression and negative internal dialogue. Gramps was a strong person, they really don’t make ‘em like that anymore! I wouldn’t say he didn’t have Bad Moods, because he definitely had his quiet days, and he would get angry at the aide if she was late or if something wasn’t done the way he liked. I can honestly say I never heard him yell or use Bad Words. He really was good to everyone. I am not just saying that because he was my grandfather, he just was a good guy.

                As for me, I am not sure what my family would say as far as my Bad Words. I am sure there are things I said that I could have said better. My intention was never to hurt anyone, but I am not perfect. I can tell you, I once got angry at my Aunt, but you know, I apologized immediately as I just snapped and normally would never yell like that, but it was all too much. It happens.

                I can tell you my feelings were also hurt – a lot. I didn’t say anything. Maybe there was nonverbal communication and it came across anyway; I don’t know for certain. I do know for certain that internalizing the hurt is unhealthy. You have to find your voice, but use it wisely. If you complain about everything, it won’t do you any good. Strike a balance.

I think the world would truly be a better place if people took a moment to think before they speak, choose their words wisely, based on the point they are trying to make, rather than to wound someone. If you misstep, the best thing you can do is apologize, immediately and sincerely, and try to make amends to move on.

Grey Days

               I went to the Biltmore in Coral Gables last night and heard E.L. James, the author of “Fifty Shades of Grey" speak. That book has no relevance to Caregiving, (and if you are familiar with the trilogy you now it isnt even close!), but, basically, today I am inspired by all things grey.

                When I was a Caregiver, I longed for the simplicity of “black and white.” A trip to the doctor is a great example, of how you want your options laid out in clear cut terms, but the doctor is not prescriptive, and will lay out your options, but ultimately the choice is yours and for decisions, you are on your own. It’s maddening!  It’s all for good reason though. Doctors can give you options and tell you the statistics, but there are so many variables that each case is individual. Doctors cannot predict which end of the bell curve you will land. Medicine is a science, but it’s not exact. They can’t tell you, “if you do this, here is your outcome” because there are no guarantees. They lay it out and talk in terms of “prognosis” or “best practices” and they can make recommendations, but they can’t decide for you. You need to navigate the murky, grey waters and decide for yourselves. This is one time in your life you actually WANT someone to tell you what to do, but the system doesn’t work that way.

                The best way to navigate through the grey is education. Research your diagnosis and condition online on reputable sites like WebMD or Livestrong. There is so much information available at your fingertips, so make that effort before you make your decision. I will caution you that, while I recommend being educated, I do not support becoming obsessed. If you find yourself 25 pages and 5 hours into a search, you may be on the downside of the slippery slope into an unhealthy obsession –don’t go there! Get as much information as you can and need to make a reasonable determination to move forward.

                Leave the doctoring to the doctor. Related to that point above, it is important to be educated, but realize your doctor is the one that went through medical school and if you don’t have MD, DO, RN, PA or such credentials next to your name, leave the medical practice to the professionals.

                I also recommend writing down your options with the pros and cons. Weigh your choices carefully. Prioritize based on what is important to you and what you think is feasible. With health, I find you can’t get too far ahead of yourself- one step at a time. So maybe your first step is another test to get more information or maybe it’s taking a prescribed medication and dose, and then you progress from there. This will read corny, but here it is - the only way out of the grey is to take it day by day!