Guilt: The Most Tenacious Emotion

Mr. Guilt gets it wrong so much of the time, skipping over people who should feel its punishing pinch, and injecting its emotional pain into compassionate people who should be fully at peace with what they are doing or have done. The public pictures chaplains hearing confessions of sin that people feel guilty about. But  patients and families under my care rarely have wrongdoing to reveal to me, such as skimping on care for a loved one in order to ultimately have more money for themselves, or confessing to assault, harassment or any other kind of crime from their past. Much more common is the guilt for things they should not feel any guilt about at all, and if anything, should be at peace with or even proud of.

I am thinking now of a patient Matilde, who has been so religious all of her life that “she almost became a nun,” a child of hers said. She is confined to bed. When I see her, she speaks Portuguese and she settles for my Spanish as a linguistic compromise.  At each visit, she laments that she cannot get out of bed and go to Mass. I assure her that God is everywhere, including her room, and usually this does not console her. But one time I said it again and went into more detail, and to my consternation, she started to cry even more. “What did I do now?” I  (guiltily) wondered to myself. Fortunately her sister was visiting and she could translate the amount of Portuguese the patient was saying that I did not understand—which I assure you was a substantial chunk. She translated, “I am crying from happiness, not distress, because you brought God to me.”

As moving as that was, assuaging guilt is the exception. Trying to do so might even let Mr. Guilt become even more entrenched. I have to remind myself that instead of talking a person out of guilt to let them talk about their guilt. This is really no different from how the helping professions should operate regarding any kinds of changes for the better they yearn for their clients to make.  We have to ask questions that will unearth hidden angles. We have to refrain from giving them the distraction of resisting our suggestions of “Don’t feel guilty” instead of exploring what ghosts past and present are fueling it. Clients have to find the end of their guilt trips on their own, and all we can do is illuminate the obscure segments of the journey.

Sometimes I am lucky enough to see Mr. Guilt being let out at his last stop when a client talks with me about their guilt during a series of conversations. There was the case of a patient’s son, who I will call Samuel. His mother, who will get the name Jackie, was a patient of mine for around a year. I saw that when he visited her, she would needle him about this or that and make sarcastic jabs at whatever came to mind. When I spoke with Samuel about this after his visits, over time he built up a story of family relationships with plenty of twists and turns for guilt to ride along in. I was surprised first of all when he said his mother favored him over his other siblings, given all her hobbling negativity towards him. (If that is favoriting, I wonder what his siblings dealt with; i.e. “With friends like that, who needs enemies,” as the saying goes.) Over time Samuel talked about his sources of guilt, amply supplied not just from within, but from his siblings. The gist was that they accused him of not giving his mother enough care, the right care, enough money, enough visits, and so on. No praise and certainly no encouragement that I supplied about his compassion, his constant visits from far away, no lamentations over the hostile texts and emails from the sibs which he had showed me, served to derail his guilt. Of course guilt stalks a favorite child, so I knew this was part of the story, which we discussed. I suspect even Joseph felt ill at ease as much as he reveled in his coat of many colors. Still, covering that did not make any headway either.

I soon refrained from praising him and discussing favoritism and over time uncovered a clue that at least took guilt out of the driver’s seat: “When you feel guilty, this lets your sisters do their job for them. They don’t have to feel guilty about anything they do; they just lay it all on you and instead of them beating you up, you oblige and do all the work of beating yourself up for them.” For the first time regarding his guilt, Samuel said he felt “lighter.”  A day later he emailed me that he was sleeping better. Ah, Mr. Guilt, I got you that time!!

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In Praise Of Euphemisms

The way some people pooh-pooh euphemisms you would think they were a miniature form of fake news. When I was a chaplain intern I was admonished, “Don’t say ‘pass away’ or ‘ she is in a better place.’ Tell it like it is and say the person died or is dying.” I do get the point about being honest and direct about a painful and scary subject, and that such directness is a corrective to all the death avoidance in our culture. Euphemisms can even do great harm by breeding misunderstanding. I have cautioned families with small children that if they say “Grandpa went to sleep” the kids might be afraid to go asleep and suffer the same fate, or they might keep hoping Gramps will wake up. Clear language also may help the mourners grasp more quickly that their loved one is going or gone and that it is time to go forward on their grief journey.

But sometimes euphemisms may be exactly what the chaplain ordered. The problem with directness is that it can be, well, too direct. Is it always necessary to drop the unvarnished truth on someone all at one go? Maybe truth in small doses is more manageable. Sugar-coating has its place if the alternative is not to take the dose at all. After all, what family member can take in all at once that death is imminent? So many times I talk with family on the phone when their loved one is on hospice who ask me if the patient talked with me during my visit. This is after I see the patient  just prior to the phone call and observe that he is completely unresponsive and glassy-eyed, which means, to coin a new euphemism, he is about to become a part of world history. Rather than necessarily say, “I’m so sorry to say this, but it seems that your husband is about to die and probably has only  a day or two left,” I might say, “I think he is not speaking now because he is turning inward and preparing for the end.”  That is pretty clear without mercilessly rubbing in the details. And even with that, the family might go on to chatter about the patient feeling better tomorrow.

Sometimes I use euphemism as an entrée into general discussions on death. After all, the title of my book, which is about true stories my hospice patients told me, is a euphemism! (The title is Encountering The Edge.) And if you are a health professional reading this blog post, you may well know that humorous euphemisms are a part of self-care. So very many times I have joked with my own husband, a baseball lover that so-and-so is “in the bottom of the ninth.”

Next time you see that someone is in Act Three, Scene Three, consider euphemism as one tool among many for helping others as well as yourself find a byway when the main road is impassable into that most formidable of subjects, death and dying.

Loss Is In The Details

I would never have noticed except that Pam pointed it out to me as I looked at her mother Nora sleeping in the hospital bed:  She did not have any eyebrows.  There were two crescent depressions in their place. “That’s because when Mom was eighteen years old she thought she would be smart and shave off her eyebrows and put makeup there to look like she had them. But they never grew back. So I would always see her, flipping out her little mirror, and making her quick little movements with her cosmetic pencil to make them keep looking like they were there. So it’s weird looking at her face and not seeing anything there where the eyebrows should be. So I miss seeing them there and now that she is too weak to use her liner I miss seeing her fill in those two bare recessed spots on her face.” Thus her mother had surrendered even her stand-in eyebrows for good.

Nora’s granddaughter Merced was there too, reminiscing about this micro story of the eyebrows as well. Meanwhile I could not help but notice that Pam’s and Merced’s eyebrows were only minimally present on their faces, like the sketchiest of crescents.  After everyone ran out of things to say about eyebrows, the talk tilted away from intimacy and more towards small talk, as if they were afraid anything more than a normal pause would hint they had enough of seeing a hospice chaplain and that I should go. Merced announced she was a real estate agent. I said, “I bet you encounter plenty of emotional drama with people buying and selling such an important thing like a home.”  “Oh yes,” she agreed. “Each home has its own story.”

I thought about Merced’s remark, and all that it implied. So much emotion and personal history is invested in the places we dwell in, and so much loss and confusion faced when we sell them. Then there is so much disorientation upon occupying another. If one little thing out of place like eyebrows gone missing can throw us off it is no wonder what a confounding experience it is to move into a new place.

Nora of course, who had transferred to a hospice residence, was in alien surroundings.  But almost constant sleep guarded her from registering all the other things she had given up besides the mock eyebrows. She still had one more “home” left to move to, and the story about that place is perhaps the one most often told albeit with so little to go on besides the hypotheses of one’s religion.

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Reprinted with permission from the blog, Expired and Inspired in the Jewish Journal, June 27th, 2018 at this link: http://jewishjournal.com/blogs/expiredandinspired/235492/loss-details-rabbi-karen-b-kaplan/

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On a personal note, this week marks the 5th anniversary of my blog, Offbeatcompassion. Would that be considered a “venerable” age in the blogosphere?

Not The Last Word On Last Words

There is a mystique out there that a dying person’s last words will contain rare wisdom or will give us a clue about what awaits us in the Beyond.  Emily Dickinson’s last words were supposedly, “I must go in, for the fog is rising.” Even if she did say this, for the overwhelming majority of us, the idea of our last words being jam-packed with significance is just a romanticizing of the end of life. The death scenes in many movies of a loved one saying a few brave words, letting out a sigh, and then turning their head away as they painlessly depart are no closer to the truth.  Also, I am skeptical of people having the presence of mind at the very end to be witty as in the famous quote by Oscar Wilde, purportedly his last: “This wallpaper and I are fighting a duel to the death. Either it goes or I do.”

Sorry to shatter this myth, but my experience on the job as a hospice chaplain is that last, or close to last words, are often mundane or consist of expressions of discomfort. “I am thirsty.” Or “I’m dizzy.” Or, “What time is it?” Or, “Oh my stomach hurts and I have to go to the bathroom” is more likely. Or something confused, as when I gave a woman some tepid tap water and she said, “That is the most delicious thing I have ever tasted.” There may not be any words at all, of course, if the patient is unresponsive or can no longer verbalize or is unintelligible or incoherent.

If it is any consolation, “next-to-last” words of a person still relatively clear-headed and sans dementia, can have more significance. “I love you” is very common, as are expressions of concern that the patient’s loved one will be able to get along after the patient is gone. Sometimes I do hear questioning of what their lives were all about, or declarations of faith or what has mattered most. One of my patients talked at length about some poems he wrote in a book he gave me as a present. He loved having me listen to him reading a few aloud and getting my reaction. He even asked if I would promote his book in my blog, something I could very much relate to as an author myself. Not many days later his life ended. In his memory I will mention the title of his book: Lifelines by Ben Verona (He chose this name, a pseudonym, because he thought it sounded Jewish and romantic and would attract female Jewish readers!)

Perhaps we want to think literally about final words because of the unknowability of death itself; as if part of what death is all about “seeps” into the final moments of life, throwing us a clue here and there. But unlike a novel or a film, alas for us real people, loose ends are left loose, and the ending after the ending is left undisclosed.

Fast Backward

Juliet, the wife of a patient of mine, used to work at the residence where I now serve as a chaplain before it became a hospice. “It was a place for elegant ladies,” she said, fondly reminiscing about the luxurious setting she experienced there some sixty years ago. “I would prepare their lunches and set the plates in front of them by the hand -carved napkin holders on the linen tablecloths and run other errands. And they wore gloves as they ate and most of them wore tiny white caps on their heads. They were so well-to-do. And another thing, if they wanted to leave the premises, they had to sign out with the receptionist to go out to lunch (never mind dinner) and then sign back in when they returned.” As she relived that time, I wondered where all this quaint standard of behavior really happened. In Mayberry perhaps?

The residence is actually in Elizabeth, New Jersey and still has the features of a mansion, such as chandeliers, a stairway carpeted with a floral design, sun rooms overlooking a gushing fountain, a miniature walkway, and gardens that meet the standards of squirrels and Siamese cats. One of my other patients there, who had been homeless, felt he too had fallen into the lap of luxury, as if sensing its former classiness. “This is like a hotel,” the former motorcycle repairman told me. “I get food brought over to me anytime I want and don’t have to do anything. I can stay in bed all day if I want.” He also liked not having to hustle for drugs and could get all the pain medications he wished on demand. His friend even cautioned him to treat us staff “real nice” because it was a special place and he should not do anything to get thrown out. But both of them knew darn well what he was there for, and the patient took a guess that he would last for two months and then that would be “it.” He figured the residence was a great warm-up for the hereafter. Nothing like ending on a high note. But before “it” happened, he showed me pictures of the detail work he did for motorbikes, and had me run a tape of a band he had played with on a cassette player borrowed from the recreation room.

The inhabitants at the residence, like the mansion itself, keep transplanting me back to their individual pasts as I listen. With so little future ahead, they prefer to unravel their own long histories rather than poke around their Spartan present. As I listen, I do the opposite of what you might expect from a chaplain: I midwife a rebirth of what has already occurred; I do not flash forward to presume what a patient may expect in the Beyond.

Book Review: Starting With Goodbye: A Daughter’s Memoir of Love After Loss by Lisa Romeo

If an author is not famous, the trickiest thing about writing a memoir is to include material that interests others besides friends and family. This book makes that leap for the most part if you are grieving the loss of a father and your grief is ambivalent. That is, he was not abusive, but he lacked essential ingredients of closeness present in a healthy relationship between him and you as a son or daughter. If you are grieving a father who connected with you in some ways but not in others, and especially if he suffered from dementia in his final years, you will identify with Romeo (with a name like that who needs a pen name?) and feel that she has validated your mixed and confusing feelings of longing, resentment, remorse and perhaps admiration. If you are of Italian descent, you will find even more to relate to, with the author’s details on her Italian heritage.  As a “bonus” in this book, she has profound insights about dementia: “Did he know that his fondness for home, the spiked worry when not home, was him not being an old fart, but him needing to stay safe?”

Having to summarize her book in one word during a question and answer session, I was fascinated with her choice of “insistent.” I think this means she yearned to bridge the distance she and her father had created by using her imagination to “talk” with her dad after he died.  She explains, “I know that, for reasons I don’t completely understand yet and maybe never will, I’ve constructed this father to fill in for the one I could not talk to before.” Talk about yearning! Throughout the book she refers to second chances and how her “postmortem conversations” helped her gain more insights about her father and  accomplished the work of grieving.  By doing this, she is comforting readers who have felt something akin to this, thereby normalizing their feelings and helping them grieve as well.

As I read through Starting With Goodbye, my motivation for continuing to the end evolved. First I wanted to know what she meant by having conversations after the death, and what it means to have a relationship after the death, and what the conversations were about.  She is up front about imagining these dialogues as a tool to self-understanding, implying its relevance to the reader.  But hospice chaplain that I am, I started to analyze why she had the conversations. I was aroused to do so when she stated that guilt was not the issue in her “unfinished business.” I think it very much was, and I state this not to “win” an argument or show off, but to make the book even more relevant to a griever dealing with ambivalence toward a father or to any key family member. I also mention it because guilt and the like need more recognition as one of the tasks of normal grieving, especially in conflicted relationships. Romeo mentioned over and over how she regretted playing her own part in keeping a distance from her father, either through her sarcasm to him or avoiding visits as an adult.

If she is still grieving, then the part that may be unfinished, or had been unfinished while writing the book, may have to do with guilt or its cousins such as remorse, regret, and resentment. These emotions are a key component of ambivalent relationships: we yearn to be close to someone who could not be fully available that way. Yet we feel repulsed and rejected by the behavior that barred us from emotional access to them in the first place. That is indeed a painful thing to mourn. Romeo may not have explicitly stated this, but her whole book pulsates with this paradoxical theme, thereby rendering spiritual and emotional healing to  readers who themselves are stuck in this agonizing push-pull with loved ones even beyond death.

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Lisa Romeo is a manuscript editor and consultant. Her nonfiction is among Notables in Best American Essays 2016 and she has been published in The New York Times.  Her book is available on Amazon and Barnes and Noble as well as from independent bookstores. Her YouTube video is here: https://www.youtube.com/watch?v=zJENeXCAKbs

Disclosure of Material Connection: I received this book free from the publisher. I was not required to write a positive review. The opinions I have expressed are my own. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

Why I Sing To People Who Are Dying

Announcement: This is the title of my guest post in a new blog called samada.com, which I think of as a one-stop shopping place for all your end-of-life needs.  The link to my post there is https://samada.com/health/singing-to-people-who-are-dying/

Tomorrow May 25, 2018 you can stop in to Offbeatcompassion for my book review of Starting With Goodbye by Lisa Romeo, who talks of dealing with her ambivalent grief through imaginary conversations with her father after he is gone.