Tuesday, January 28, 2014

A different approach to the end of life - a guest blog from Molly Yarger

    This blog is a guest post from my daughter Molly.  Shortly, she'll finish her last few courses, a clinical and then her licensing exam, but if this blog is any indication, I'd say that she's ready now.       

As I sat and listened to a long-time hospice nurse speak to my senior nursing class, I was moved. My eyes welled up with tears, though my calculated stoicism allowed none to fall, as she described her experience with hospice patients. I had been removed from the geriatric population, it seemed, just 
long enough to begin to lose some of my passion for nursing. By the end of the address, however, I began to feel that old familiar inspiration that initially drove me toward nursing as both a career path, and a lifestyle. My passion was renewed just when I needed it (perhaps by chance? divine intervention? I’ll let you be the judge).

Modern medicine can accomplish some amazing feats. The treatment and eradication of illnesses continues to improve day by day. That being said, modern medicine is also mainly concerned with “treating.” A terminal diagnosis ends the possibility of eradication. When a terminal diagnosis occurs, therefore, it as treated as a perpetual end point for modern medicine. Many patients feel a sense of powerlessness.

Simultaneously, this is the beginning of end-of-life (and hospice) care. We cannot change the terminal nature of the diagnosis. We are nurses whose patients are headed toward imminent death. These patients feel as though their power has been stripped.

The inability to “cure” our patients, however, does NOT mean the inability to restore this power. We treat our patients holistically. That is, we care for our patients’ bodies, minds, and souls. Rather than falling into the trap of perceived powerlessness due solely to terminality, we take an active role in empowering our patients. They cannot, unfortunately, “conquer” death. This can be difficult for 
patients to accept. We do everything in our power to ease them through this difficult process. Once acceptance has occurred, we are able to move forward and place the focus on that which the patient may control. We assist them in reframing their thinking to help them understand that they DO have power to make decisions specific to their individual preferences. The patient DOES have the power to choose whether they’d like to pass on at home or in a hospital setting. They have the power to choose how sedated or non-sedated, they’d like to be. They have the power to choose which activities they participate in “just one last time” (or even for the first time) before they go. They have the power to choose to see those they want to see. Often patients will hold on just long enough to hear someone’s voice one last time. Sometimes they’re waiting for a loved one to arrive before they can go peacefully. There are even those who seem to wait just long enough to be left entirely alone before passing on.

But eventually, the conclusion of this interaction is death. Ideally, I’ve guided my patient (and their soul, I feel) through to the next era of their existence peacefully, comfortably, and in the setting/manner of their own choosing. I’m not even going to begin to describe what I think that “era” 
is, nor what it involves. I could write volumes guessing. But what I do know is this: terminal illness does NOT equate to powerlessness. Healthcare professionals treating terminal patients must actively work to empower their patients. Sitting in that room, listening to memory after memory from a hospice nurse, I was moved. These patients cannot choose not to die. (At some point along the way, nor can we.) But we can all choose how we would like to live… no matter how long we may or may not have left. There is nothing I perceive as more humbling than being able to not only ease someone through the dying process, but empower them through it. It is a role that, pending one last semester and a passing grade on my NCLEX exam, will humbly and graciously fulfill… perhaps for the rest of my days, if I so choose.

Tuesday, January 21, 2014

The Master Manipulator - a guest blog from sister Wilson

    This morning's post is a guest blog from my sister Wilson.  I'm not saying that she is right on anything that she reports below, although there is strong evidence that she is correct, the strongest being that I am currently in the Bahamas and she is writing a blog and babysitting my son. 

    You may not realize it, but last week’s blog (a few burnt ends) was intended for me.  You see, the Ongion asked me over a year ago if I would be interested in writing a guest blog, and although I responded in the affirmative, I just hadn’t quite gotten around to it.  A few months ago, he dangled
the idea that he was considering wrapping up the blog in the relatively near future, and had hopes of compiling it into a book for his children.  He appealed to my ego that such a book just wouldn’t be complete without a guest blog from me.  What the Ongion forgot to realize, however, was that unlike him, I am not at all motivated by my ego….so I still hadn’t gotten around to it.
Earlier this month I accepted a job offer, after years of being a stay at home mom.  I can imagine the Ongion, sitting at his desk with the realization that if I hadn’t made time to write a guest blog when I wasn’t working, there was little chance that I would get around to it, once I was employed.  It was time for action. So today, he published a blog entitled, “a few burnt ends.”  Out of 
You know who also manipulates?  Nick Fury, that's who
all of the blogs that he has published thus far, this was the worst.  He claimed technical difficulties, but I don’t buy it.  It was disjointed.  It made me think about the bark on a pork butt and the gross things in a hotel room all while being assaulted by a series of painful malapropisms (a word that he pluralized with an apostrophe.) He even posted it late. To those of you who do not know my brother as well as I do, this may seem innocent….but that is only because you have not yet been exposed to a deep layer of the Ongion.  You did not grow up with the master manipulator.

     When we were growing up, we children were always given assigned chores.  Most of us, like them or not, completed the chores and moved on with our lives.  Not the Ongion.  His mantra was to work smarter, not harder…and his goal was to minimize any and all chores that might come his way.  If it
was his job to dry the dishes, he would inspect each piece of cutlery and dining ware that came his way, and inevitably find a spot or grease mark that would prompt him to pass the item back to the washer for further cleaning.  If you were the washer, you either had to remain captive to the whims of dish inspector #12 for the remainder of the foreseeable evening…or excuse him from his duties and wash and dry the dishes yourself.    More times than not, it felt less painful to spend a resentful evening alone at the sink then put up with the antics. Lest you think we could simply complain, you must know that my parents would not tolerate any fighting over chores. If bickering erupted around a chore, we may as well hang a sign around our necks that read, "oh, please, give us additional work".  Lest you think I could simply retaliate, I was seven years
2/3 of a sandwich according to The Ongion
 younger than the Ongion, and had vowed that I would never grow up to be that mean.  So the Ongion would nitpick us into frustration, and his eventual release from duty,but stalling was just one tactic  
that he employed.  There was another that was even more annoying, and unfortunately on me, the most effective.  I refer to it as the dry cheese sandwich approach.

     One of the chores that was in our rotation was the task of making lunches for the children in the house.  I am the youngest in the family, so this chore usually meant lunches for just 3 of us; the Ongion, myself, and one other sibling.  The parameters were few.  You could make anything available in the house if there was enough to go around.  Peanut butter and jelly was the most common, which involved having to stir the oil back into the peanut butter to make it soft enough to spread.  Occasionally, there was fluff.   There may have been lunchmeat, now and again, but by lunchmeat I really only mean bologna.  There was cheese, and with just 3 kids left in the house, there
The other 1/3
was canned tuna.  Almost any time the Ongion was assigned the chore
of making lunches, I knew the conversation that would occur the following morning, and every morning that he had that chore.

Me:  “What are you making for lunches?”
Ongion: “Dry Cheese Sandwiches”
Me: “Dry cheese sandwhich?  That’s just you putting one slice of cheese between two pieces of white bread. Can't you at least put mustard or a slice of bologna with it?"
Ongion:  "Nope.  Dry Cheese Sandwich”
Me:  "Gross."
Ongion: “Well, if you don’t like it, you can always make your own lunch.”

     So the choices for me was either make my own lunch, or try and choke down a dry piece of cheese between 2 pieces of clearance rack white bread.  Master manipulator.  Man, he was good.
So, my other sibling and I would usually acquiesce and end up making a can of tuna, making our sandwich, and heading off to school, at which point the Ongion would swoop in, and make himself a tuna sandwich with our leftovers.
See, I told you he was good.
So when I was reading his blog this morning, call it PTSD, but all I could think was “He’s dry cheese sandwiching me”….  If I don’t like it, do it myself.

So, Ongion,  you got me.  I promise next week I will do my guest blog.  And I promise, it will be better than dry cheese. - Sister Wilson

Sister Wilson and the Ongion

Tuesday, January 14, 2014

Just a few burnt ends....

     For those not familiar with this BBQ term, burnt ends are the really flavorful pieces of meat that come from the tips of a beef brisket.  They are full of flavor but their burnt appearance turns some folks away and they can be a little tough to chew, but if you've got a taste for them, you can never get enough.  The bark on a pork butt or pig is similar and my brother Ace and I go round and round about whether to include it in the meat trays for sandwiches, I say yes and he says no.  This morning's blog is a collection off those tasty little bits of blog idea that I've had that I just couldn't expand into a full blog.

     Just because we disagree on the bark issue, that does not mean that my brother Ace and I don't get along.  I devoted a whole blog to him one time and we spend as much time talking to each other as we do our wives.  This gives me a unique opportunity to pick up on his little idiosyncrasies and his mastery of malapropism's is one of them.  He frequently substitutes the wrong word, but a close one, into his phraseology without even knowing he is doing it.  Almost every time we speak, he utters one of these, and I've always meant to do a blog on them, but I never remember to write them down and I can never recall enough of them to fill a blog, but this morning I'll give you the first one I remember and the best one.  He always has said "Nip it in the butt" instead of "nip it in the bud".  Most times he is talking about his work and it creates a quick comical moment for me when I picture his coworkers running around trying to nip his butt, and I've corrected him several times, but I think it's too far ingrained in his grey cells for him to change it, so I silently chuckle when he uses it now.  The one I was totally unprepared for, however, he used one time while discussing his feeling alienated in his office and he told me that they were "treating him like a leopard".  That one cost me a pair of pants cuz I spit my coffee out laughing when he said it.  I can easily imagine what it would be like if they "treated him like a leper" but had a much harder time imagining the former.  Sorry Ace, but I had to share that one.  

     I get a lot of articles forwarded or shared with me about how hotel rooms are not really cleaned as they should be.  These are not helpful.  I am aware that the glasses may not be clean and no I would never even consider bringing a black light into a hotel room with me, because, at the bend of the day, I still have to sleep in them (see what I did there?).  I can't wear a hazmat suit while I travel so I just have to accept the fact that I don't know what I am coming in contact with in the hotels, but ignorance is his, so I  Kerry on.  

     There's a great family story about my mom making mud cupcakes and tricking my oldest brother into eating one, but while it's a great story, I, Shirley couldn't make it into a hole blog, could I? 

     I'm likely not as clever this morning as I think I yam, so I'd best try to finish quickly.  The blast thing that I would want to do is to alien ate my readers, less they treat me like a leopard. 


Tuesday, January 7, 2014

The Canandaigua of my youth......

     If it's true of every generation, to age and then to wax nostalgic for the simpler time that they knew, is it more true of mine?  Did the generation before me wish to go back to hand pumping water and using outhouses because they remembered the simplicity of those times?  I'm truly not sure, however, I find myself more and more, wishing that my children could have experienced the city of my youth as I knew it, and I'd go back and live there in a New York minute if I could, and never miss a thing.

     It seemed like there were more hours in a day when I was young.  Maybe this was because we got up earlier, things took time to cook and to prepare and you had things you had to do before you got
Norman painted my life often
ready to go to school, so there may actually have been more hours in a day then.  I grew up in the 60's and 70's in the small city of Canandaigua NY.  It had a population of under 10,000 then, and the city itself really has only grown about 10% in population since.  Oddly though, it seemed like there were more people then, than now, because they were always outside.  Our high school football games drew capacity crowds, and the church of my youth was full, so you went early to get a good seat, and not just on Christmas.  I'll take you through a typical week.....

      On a normal school day you'd arise an hour or two prior to the first bell.  You'd do your morning chores and then any extras that might need to be done.  In my house, if you were a male, you were likely an altar server and you might have to walk back and forth to church, prior to going back there for school to serve the early mass.  In winter you might have had to go out and shovel the walks and driveway prior to school, and when you were done, Dad was sure to "suggest" that you do the same
for an elderly neighbor or two.  Inside lunches and milk were being made, and..... Wait, you didn't make milk as a kid?  In my house, milk, for a lot of years, came in a big box marked Carnation, whose magic crystals would become milk when you added hot water.  This was best done the night before as hot instant milk is surely an acquired taste.  When you were done with breakfast, mostly Buckwheats and Oatmeal, you'd pack up your brown paper bag wrapped textbooks, slip your small feet into plastic bread wrappers and then your boots, and then you'd walk to school (yes, uphill both ways, carrying your brother).  The streets were full of kids just like you.  In school, you'd behave or when you got back from the Principal's office, you'd find it harder to sit on your seat.  There were chores at school too, clapping erasers, emptying trash, washing desks, and anything else that you were asked to do.  After school, you'd check back in at home, and then have a few hours to explore the city or neighborhood parks. 

   I'd arrange to meet back up with my friends downtown and we'd walk the streets exploring.  We had to arrange it ahead of time, there were no cell phones and if you screwed up the plan, well, you missed out on the plan for that day.  More commonly now kids step out their doors and then call to
The original Leroy Brown
 see in which direction to point their feet or their cars.  We'd look in the windows of the stores, Valvano's Newsstand was one of my favorites.  We could browse the newest comic books that we couldn't afford and they always make sure to kick us out before we finished the story.  We bought cheap magic tricks and modeling clay and playing cards to put on the spokes of our bikes.  A lot of times our homework would require a trip to the library to do research, so we'd head over there and look among the stacks for the reference books that we would need and while there we might check out the latest Encyclopedia Brown Book.   Frequently on our trips to the library, we'd detour into Seneca Dairy and buy chocolate milk or ice cream in a cup.  Soon it would be time to head home for dinner, and in my house, you weren't late for dinner without a very good excuse.  You all sat down together and shared your days, and then after dinner was done and dishes were washed and dried by hand, you might settle in to watch some TV, not of your choosing, but what your father wanted to see.  At bedtime, you were reminded to brush your teeth and to say your prayers. 

     On Saturdays we'd have our weekly chores to do and then settle in to watch the Saturday morning cartoons.  Many mornings there would be pick-up football games arranged or we'd plan a longer exploration.  I remember taking my bike and riding to Manchester or Cheshire with friends to see the
sites there. Sonnenberg Park was a regular destination for me and we'd climb the trees, play foursquare or play some basketball.  It was common for us to be gone all day, or home just for lunch and then back out again.  We had more time to go downtown so the candy stores like the Goody Shop or uptown, the Corner Store were great places to spend some time.  Some Saturdays, Dad would announce a work day and take us to our Uncle's garden to spend some time there weeding or harvesting.  Sundays would start at church, early again, 7:30 and then if we were lucky we took the car to one of two bakeries, Schreck's or Vecchi's to pick up some donuts.  This was likely the first time in the week that we would ride in the car.  After we got home, Dad would read the paper and we'd wait until he set down the comic section to grab it and read it.  We'd take the wax wrapper from the cereal box and make imprints of the comics on them.  Abbott and Costello movies
were on the TV regularly that morning and if we stayed at home in the afternoon, we'd watch the Yankees play.  We'd eat an early dinner (lunch) and most weeks Dad would pile us in the car to go visit an Aunt or Uncle.  Sundays were for family and Dad took this seriously.   Sunday nights were for finishing homework and I remember taking religion classes with my Mom, since she didn't think I was learning enough at the Catholic school that I attended.  We'd watch "The Wonderful World of Disney" before bed and we'd see classics like "Herbie the Love Bug" or "Old Yeller" (Travis, get the gun). 
     I'll close this walk down memory lane with a brief description of the Canandaigua summers that I knew.  Long days in the park with Boone Baker, and the rec program featured variety shows or costume contests in addition to the shuffleboard tournaments.  We'd walk down to swim, but not in a 
cordoned off area, we had all of Kershaw Park and the pier to swim from.  We'd fish in the outlet, and a few times a summer we'd go to Roseland Amusement Park.  I'd be remiss if I didn't mention that the Kiwanis Club sponsored one of those trips with the Sunshine Special, which would give you free tickets for good grades and a trolley ride to the park too.  The civic groups then were numerous and well attended, and some even had thriving youth organizations.  Now, some are non-existent or struggling for active members.  The summer wasn't complete without a week long visit to stay with an Aunt or Uncle just at their house or at a cabin or lake house.  We'd take camping vacations regularly too.  Maybe I am a little too nostalgic about my youth in Canandaigua, but maybe I'm not.  I was ignorant of world politics, talk of crushing debt and political upheavals, and could just play without worry, all day.  Sadly my kids will never know that world.