Folk Philosopher

Ricky, who designed and painted parts for rare cars and motorcycles, proclaimed: “I’m gonna drop dead in two months.” That is how he opened the conversation when I met him for the first time as my patient. Talk about cutting to the chase! Quickly adjusting gears from an opening greeting to this steep fall in topic, I asked if he was afraid of death. He replied, “I am not afraid of things I can’t change. I’m only afraid of things I could change but I don’t.” Ricky was not able to elaborate. He moved off to the relatively lighter topic of the motorcycle he built for himself and decorated by himself but would now have to sell (for obvious reasons).  Maybe he meant by his remark that he was afraid of living with guilt and regrets. Or maybe he meant he kept doing things that made him unhappy.

I can only speculate, but what grabbed my attention was that Ricky feared dealing with choices more than dealing with fate. Usually it is the reverse for most of us, is it not?  Perhaps for him, uncertainty and lack of confidence to better himself was scarier than the certainty of his fate. Can’t control it? Then no responsibility for what happens. There is just sweet surrender.

Maybe a small part of us in some remote corner of the psyche can admit to identifying with Ricky. We can be passive about certain things. Perhaps what we really fear is having less and less control over doing a given thing differently because we have built thicker and thicker emotional walls to surmount. This then blurs the distinction between fate and choice. I trust that our self-sabotage is far scarier for us than any Halloween image we may encounter tonight.

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Grief Lesson For Petless People

If you think people say the dumbest things to you when you are grieving for family or friends, just wait until your beloved pet dies. Or if you are the one saying such things to pet owners, you won’t ever again be so insensitive after you read the guest post below by Dr. Dolores Spivack. A tear might just creep out of your eye.

I Miss My Cat    

When your pet dog or cat or bird dies, nobody sends you flowers or donates money in its name to a favorite charity, not even the American Society for the Prevention of Cruelty to Animals. If you get any condolences at all, your friends will say at best “Sorry and did you see the game last night?” Some people have even said to me “Your cat died, so now you don’t have a cat.” I miss my cat.

My cat, Mel, died two months ago after living all of her eighteen years with me. She was born right into my hands after her mother’s difficult labor. No bigger than a small potato, I massaged her chest with my pinky finger and Mel took her first breath in the palm of my hand. I then helped her mother clean her and nurse her.

At the end of her life, Mel only had one tooth and was almost totally blind. Because she shook her head so much after her second stroke, her ear shriveled leaving her only one ear. She was equal to about one hundred in human years. But, she could still navigate the house, find her litter box, and jump on the table. If, and when I reach one hundred years old, I want to be able to jump onto a table just like her.

I miss Mel. I miss her faithfully waiting for me to come home, even if all she wanted was her can of food. I miss her underfoot, even though I often stepped on her tail. I miss her scattering of toy mice I would give her as holiday presents. She couldn’t catch the real mice, only the toy mice. That made me laugh so much. The toy mice only collect dust now.

I knew she was important to me while she lived. I did not know how cherished and how vital she was to me now that she is gone. I find it difficult to explain to my family and friends how much I miss her. Often, when I wake up in the morning, I think I feel her cuddled next to me. Then I remember she died. I miss Mel.

My grief for Mel is as deep and sad as any I have ever felt for any human, friend or family. Why is that not acknowledged? For almost two decades, Mel made her presence known in my house; she ate her canned food with me while I ate my meals. While I slept, she cat-napped but for many hours more than me. She greeted me and all visitors with curiosity and a welcome. She was as much a part of my life as my family and she witnessed more of my life than anyone else. Why would it seem strange to mourn her loss so profoundly? All I ask of my loved ones is empathy at best or solemn silence at least.

When Mel died, I waited until I was alone to bury her. I knew I would cry long and hard. I wanted the privacy to cry how I wished. I felt no need to be strong. I placed her in the earth with the same hands that welcomed her when she was born. I sprinkled dirt over her shrouded body and tamped it firmly down while my tears made puddles of mud on her grave. I miss Mel so much.

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Dr. Dolores Spivack started a writing group to motivate her to finish her dissertation about New York City building codes. After successfully completing her PhD in Architecture, she has gone on to write creative nonfiction pieces like the one here. The survivors include a greyhound and Dolores’s husband. They both attend a yearly greyhound convention in Gettysburg. And yes, the owners’ dogs attend too.

Closing In

When I first came aboard hospice care, one of the most common topics patients would reminisce about was World War II. Fortunately I had enough historical knowledge for them to feel I was on the same page. Now, about fifteen years since I first worked as a chaplain, their reminiscences are more often about the Vietnam War. Same goes for music. Patients are starting to talk about songs I grew up with!

On the one hand, it’s nice to have more of a shared background with my patients. I can chime in with my own memories if they refer to Nixon or to the Moody Blues.  On the other, I don’t want to have all that much in common with my patients if you know what I mean. It is a reminder that as a sixty-something, I am edging nearer and nearer to the same final curtain that has started its descent upon them. I am also having to care for patients more and more often who are my age or younger.

A gentleman I met at an open mike event last week was bursting to talk with me. I had just read a portion from my hospice career book about a patient who liked to refer to me as “doll” and who knew the game for him was just about over. This gentleman who I will call Sebastian was in his seventies and was grappling with some recent deaths in his family. The memorable piece of his story was that he felt “selfish” for pondering his own mortality. In the same breath he told me that given his age, he fears death more than ever. In other words he felt guilty (See my last post on this most entrenched of emotions stemming from loss. That is, forget about trying to talk someone out of it). When I asked Sebastian what was selfish about thinking about his own death, he said, “I should be thinking of the person who died, and I should be helping my uncle.” As I think about this now, his dilemma was that his fears were overriding his efforts to honor the deceased and console his relatives. And when I told him it was normal to think about one’s own end in these circumstances, he said, “It may be normal, but it is still selfish.”  I nodded my agreement, because as I explained in my last post, it is useless to try to talk anyone out of their guilt. All I can do is ask probing questions and make comments that can increase self-awareness and self-discovery. Perhaps feeling selfish was his method for distracting himself from his fears.  Ah, the complexities of the human psyche! This reminds me we should never be so quick to think we have figured someone out and therefore know what they need or should do.

As for me, I do not feel selfish about focusing on my own demise as I serve my clients. In fact, it gives me more in common with them! But the downside as I hinted in the beginning is the fear of, among other things, a premature end. I am glad in my case that fear has won over guilt because fear can be tamped down as I learn from my patients, while relief from guilt is much harder to come by.

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To see my post about a client who did diminish my fears, see this entry from February 12th, 2018:  https://offbeatcompassion.wordpress.com/2018/02/12/how-to-have-the-final-farewell-without-fear/

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!!

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.