Haven House

Haven House is the only homeless shelter in Southern Indiana to serve fourteen counties. It is set up to house around sixty-five people, men, women, and children, per night, but rarely is it not over capacity. Most nights there are eighty-five people sheltered and often as many as one-hundred and ten. Thirty percent of the residents are from across the Ohio River in Louisville, KY. The average stay is 26 days.

Haven House, established in 1985, has been in its current location at 1727 D. L. Motley Jr. Way in Jeffersonville, IN since 1999. The facility is a rehabbed church building which you see in the photo below. V8Uqb9tCQZGsIVc26YOM6w

Besides meals and lodging residents of Haven House are provided clinical care by four volunteer Registered Nurses. These volunteers do minor treatments, monitor prescriptions, triage medical needs and maintain necessary records of treatment and health maintenance which is provided by Life Spring Health System that has a grant to care for the homeless. Once per week a van transports residents to the healthcare facility.

Residents are expected to pay for lodging ($5/night) and meals which run from $1.20 for breakfast to $1.60 for dinner. If residents have no money to pay a tab is kept and they are expected to pay when they have obtained a job. Volunteers assist residents with job applications and interviews.


Information in this post was gathered in an interview with Haven House Executive Director, Barbara Anderson on May 3, 2019. Haven House has a Board made up of six members who meet quarterly. There are five full-time employees and all other work is performed by volunteers.

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Barbara Anderson

 

For additional information on the Haven House see: https://crookedcreek.live/2019/04/02/people-are-good/

 

NOTE: These are my observations and opinions. I do not represent nor speak for Haven House. 

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Staying Alive 1 of 6

Life Expectancy

Life expectancy is a tricky term. Statistics vary greatly in the way they are gathered and calculated, e.g., whether they include infant mortality and what country is being studied. As the chart below demonstrates women have a longer life expectancy than men, but we will not discuss the possible reasons for that here. Let’s just look at ways of “Staying Alive” for all of us. 

TIME

FEMALE

MALE

COMBINED

2012

78.7

1985

62

1900

30

Current

80.1

73.4

Born in 2018

81

76

Various sources including USA Today, Statistica and Wikipedia

Staying Alive

There is no lack of advice out there for ways to stay healthy and live a long life. Every person who hits 100 years has some type of answer for the secret to their longevity. Some say a glass of wine a day or perhaps a cigar or some other thing they enjoy.

Do you have “secrets” to a long, healthy, and happy life? If so, please share them with us. I can’t say that I do, so I’ll share what some of the experts tell us. We’ll just look at a few over the next several posts.

First: A Four-Legged Friend

Those of you who own a pet will probably attest to the fact that pets reduce anxiety. Research also shows they lower the owner’s blood pressure. For those of you who may doubt this advice let’s see what the American Heart Association says.

In the journal “Circulation” the AHA recommends owning a dog, in particular. As an owner of cats, I’m hurt, but I can see one big advantage to having a dog. Dogs must be walked so the owner is more active. But, the AHA goes even further and states that a person with a dog is more likely to survive a heart attack. 

Some of my doggie friends: Luke, Jackson, Hawkeye, Monty and Aslan

 

“My fashion philosophy is, if you’re not covered in dog hair, your life is empty.” Elayne Boosler

Theme graphic by Pixabay

Depression II

Phillip

When I was in the first grade my little brother, a toddler, died on the way to the hospital. He had been ill his entire little life.    https://crookedcreek.live/2016/09/27/little-blue-bird/

Daddy

That loss brought about many changes in our family. The most profound change was in my father. Fortunately, perhaps, I do not remember details about the absences, but my father was often missing from our family after Phillip died. I learned many years later that he was hospitalized for a mental illness. In those days depression was called “involutional melancholia” and if the condition was severe the patient spent time in a mental hospital. 

In researching my father’s condition and medical records (this was before HIPAA) and eventually meeting with his psychiatrist many years later I learned that he underwent two types of shock treatments. In the late forties and early fifties, he was repeatedly given massive doses of insulin which caused a coma. The coma was then treated with glucose to save the patient from death. When insulin coma/shock therapy fell into disfavor as dangerous electroshock (electroconvulsive) therapy became the treatment of choice for depression and some other mental illnesses. EST (also called ECT) is initiated by applying an electrical current to the anesthetized patient causing a grand mal seizure (convulsion). The intended result of these repeated treatments was the improvement of depression.

Both of these methods of treatment seem cruel and bizarre and although insulin shock was discontinued many decades ago, EST remains an accepted, although infrequent, mode of treatment for depression. The side effects include loss of memory, learning problems, muscle aches, and upset stomach. In my father’s case, I believe a loss of his personality (or at least a significant change) was also an effect of the numerous treatments he underwent. 

He was a good man. He was intelligent and managed to work again, but was never quite the same person. He had to fight hard to participate in life, but he did so for many years. He died of a heart attack at age sixty-nine. 

Today

Major depression, also known as unipolar or major depressive disorder, is characterized by a persistent feeling of sadness or a lack of interest in outside stimuli. It is generally treated today by medications and talk therapy. 

 

Graphic by Pixabay

 

 

 

CPR in the Field

CPR

Everyone knows what CPR means. It means saving a life with certain breathing techniques and chest compressions when one’s heart has stopped beating. Right?

Cardio Pulmonary Resuscitation literally means heart lung revival. That puts it in a slightly different light but still sounds promising.

We’ve all seen it work over and over again on television, but is that a reflection of real life CPR? I can tell you that it is not whether in the hospital or on the street. Fewer than 20% of in-hospital recipients of CPR live to be discharged. And, this is with a team of highly skilled professionals, IV medications, and defibrillators to shock the heart.

Expectations

Many people today are trained in CPR, and that is a good thing. I’m sure that most take the training with the expectation of being able to save lives. It does happen, but the chances of being unsuccessful are high and this is often an extremely hard outcome to accept. If occurring in the clinical area there are several people involved, but if you are performing CPR as a layperson or even a professional in the field you are often alone and it is a formidable responsibility. It can be extremely difficult to overcome emotionally when one is unsuccessful.

My Experience

Many years ago I was an Emergency Department (ED) Registered Nurse (RN). I was used to “codes” which was the word we used when a patient went into cardiopulmonary arrest. Everyone worked together as a team. We started IVs,  did chest compressions, charged and used a defibrillator and we continued until the patient was either revived or pronounced dead. Needless to say with all the needed supplies and professionals working together we often were able to revive the patient and send them on to the Intensive Care Department. From there we lost track of their progress or lack thereof. We went on to the next emergency. I was used to “saves” in that environment.

When my own sixty-nine year-old father had a cardiac arrest at home it was a totally different world. My Mom wept nearby. A neighbor wrung her hands. There was no one to help as I did CPR alone for over twenty minutes while we awaited the ambulance and EMTs to arrive. I felt his sternum crack. Was I compressing his chest too hard? I became short of breath. Was I breathing the right ratio for him? My mouth bled. My father turned blue, first his ears and then his lips.

My father died that day and I have never stopped blaming myself. How could an ED RN not save her own father? My brain itemizes many factors to answer that question, but my heart keeps saying, “I’m so sorry Daddy, I’m so sorry.”

I’ve shared this to warn those of you who are so altruistically prepared to perform CPR that it might not work. It might not be possible. 

Please do be trained. Please do try if you are given the opportunity. But, please also know that it is not always in your power and be prepared to live with that possibility.

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Graphics by Pixabay

Soul 2

Soul Discussion

Not surprisingly this subject struck a chord with readers. We will not answer the questions posed in the last post. That is not the purpose of this series, but regardless it would be impossible. There is no way that we can know what the soul is or where it resides if it does exist. We can believe, but like the experience of death, there is no proof. We will surely die and if there is a soul, then we will know. This fact does not dissuade us from our beliefs or our interest in the opinion of others. https://crookedcreek.live/2017/03/27/what-i-know-for-sure/

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Oprah Winfrey – Photo from Google

Even our friend Oprah wonders, asks questions and broadcasts about this subject. In 2012 on her series “Super Soul Sunday” she discussed this very question with over a dozen of her guests. HuffPost published this information and you may read the responses or watch excerpts from the interviews in a short video at https://www.huffingtonpost.com/2012/12/25/what-is-the-soul-eckhart-tolle-wayne-dyer_n_2333335.html

Soul Opinions

The group Oprah assembled is made up of individuals from interesting and varied backgrounds. A few were religious but more perhaps were spiritual. Some work as life coaches, do public speaking and/or found institutions offering self-improvement programs. One, a medical professor with extensive name recognition in the US is Deepak Chopra who is known for his New Age and alternative medicine beliefs. Of the baker’s dozen personalities, at least twelve are authors. 

We’ll look at their comments and opinions in the next posts, but Chopra’s soul description is a good start for today.  He calls the soul an “internal reference point” and I wonder how that differs from having a conscious. He also refers to the “core” of an individual that is “eternal”. Two others in the group also intimated that the soul is eternal without using that word. 

 

What is a soul? It’s like electricity – we don’t really know what it is, but it’s a force that can light a room. Ray Charles

Part 2 of 7

Theme photo in title by Pixabay

 

Thanks

Thank You Readers

As of today Crooked Creek has 120 followers! While I am happy about the numbers, I am a little skeptical. It seems likely that some (or many) of these “followers” signed up but do not actually read many posts. I suppose my doubt comes from the dearth of feedback. Regardless, I appreciate each follower/reader, each comment and “like.”

A couple of folks have told me that they cannot “like” a post without signing up for WordPress. This is up to you of course, but I don’t believe that it would be obligatory in any way to do so. Many “likes” now come from other bloggers because they are already a part of WordPress. If you have questions, please communicate them to me and I will try to find the answers.    suebmattingly@gmail.com 

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Thank You Donors

While concentrating on gratitude, I want to also thank all the people in the US and around the globe who donate blood and plasma. We are all very familiar with the Red Cross and the crucial need for blood during times of disaster and war. What many do not realize unless personally impacted is that very vital components of plasma also play a role in saving or sustaining life.

If you will pardon the very personal account of some of my medical history I want to share with you how donated antibodies withdrawn from donor plasma have kept me safe for almost seven years. In 2011 I was hospitalized and very ill. At that time I learned that I had some serious hematological issues. There is no need to go into a lot of detail and I won’t bore you with the long names of two significant diagnoses that resulted. It is enough to say that I have a primary immune deficiency because I am no longer able to manufacture my own antibodies to fight off infections. That’s where the gratitude comes in.

The immunologist immediately began a treatment with IV antibodies (immunoglobulin) available through donated blood plasma. I responded fairly well to continued monthly treatment as evidenced by a rise in antibodies in my blood but soon these treatments had to be terminated because of serious reactions. For the following year and a half, I was at risk of and sick with infections due to the lack of antibodies. In the spring of 2013 before my 70th birthday, I was put on weekly self-administered subcutaneous (as opposed to IV) infusions of the same type of human antibodies. My antibody level immediately began to rise and it has been in the normal range for a long time now, allowing me to live with much less risk.

#250

This is on my mind because tonight as I began to document the required infusion information in my log I noted that this is infusion number 250. These years passed quickly and easily for me. All I have to do to maintain the ability to fight infection is invest a couple of hours weekly and endure 3 needle sticks in my abdomen or upper thighs. A piece of cake!

This would not be possible without the altruism of thousands upon thousands of plasma donors. Many of you are already blood and/or plasma donors, as are many of my friends and family and I appreciate each of you so very much. Some of you, perhaps, may not have been aware of all the other crucial needs for blood components. Lives are not only being saved in emergencies, but lives are being preserved for patients from birth (remember the so-called “bubble boy?”) through older adults. Immune deficiency is only one of those conditions, but I hope that my account of this diagnosis has been informative and might lead to more donors.

Sometimes we hear so much of inhumanity and selfishness that it would be easy to forget that there are altruistic people who give not only their time and money to help others through charities but some give even their blood, tissue and organs. Each Thursday evening when I assemble the supplies for my infusion, I am mindful of those who made it possible.

 


If you are interested in further information on this particular subject you may reference:

https://www.ncbi.nlm.nih.gov/pubmed/26174901

or

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935641/

 

Theme photo in title & graphic by Pixabay

Medicine 2

Sexology

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It seems to me that Dr. Scholl and his writers hedge their bets in giving advice on Courtship and Matrimony. The recommendations are pretty emphatic but then a little wiggle room for the exception exists.

Those reading this post on a device smaller than a computer may not be able to read the print on the copied page above so I will paraphrase it for you. In summary:

  • Dispositions should be studied before falling in love. To do otherwise is blind folly. 
  • Run around long enough to be sure about the person you are settling on.
  • Courtship shouldn’t be rushed.
  • Long engagements are a spectacle of the couple getting on each other’s nerves.
  • Affinity (vs. aversion?) is essential.
  • Don’t marry someone dumber than you.
  • Grow up before you get married.

I am sorry to report that a page or two of Sexology seems to be missing, but have no fear there is more information to convey. I was both surprised and concerned to learn the following: 

  • Courage in a woman is illustrated by how well she cares for her children, especially when the children are ill for “weary hours, days or weeks.”
  • The mood determines whether pregnancy occurs, i.e., there will be no conception without “sexual emotion.”  
  • Life itself should be a sober hilarity” whatever that means and homes that approach sex with “holy fidelity” . . . prepare children to “dwell in heaven.”

Now that we have all that cleared up we will in the next post move on the section entitled “Can Parents Control the Sex of the Child?” Most parents of teens today would quickly answer, of course not, they will do whatever they decide regarding having sex, but on closer scrutiny, I believe that the advice refers to choosing the sex when a child is conceived.

https://crookedcreek.live/2018/01/23/medicine/

Part 2 of 4

Medicine

The Bookshelf

Bookshelves barely exist today. Those that remain often contain old books left over from a former era or perhaps ones with some sentimental memory attached. I must admit that I still like the feel of a real book and I like to highlight and make notes in margins. I can do that with my Kindle but it just does not feel the same. I will admit though that clicking on an unfamiliar word and having the definition pop up on the screen is a valuable feature of electronic readers. 

1970s Print

This framed print from my office is a drawing by Robert Conley.  Conley’s art was in tribute to nurses who cared for his terminally ill wife in the 1970s. I love it for many personal reasons, but I’m sharing it today to point out two essential medical books of that era. The Physicians’ Desk Reference (PDR) and The Merck Manual seen here were essentials in any clinical area. The PDR was published each year and contained page after page of details about each prescription drug available.  It was heavily used by doctors and nurses alike. The Merck Manual explained diagnoses and treatments. I am willing to bet that you do not recall seeing either of these in the past thirty years and younger readers will not likely remember ever seeing a doctor referencing a book of any kind. 

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The reason, of course, is that now all this information and so much more is available and up to date electronically. This easily accessible data saves time and, no doubt lives. One only needs a handheld device to answer any inquiry. 

1910 Manuscript

Recently I ran across a few pages I had photocopied from an old book at some point long ago. I have no recollection why I had them or had kept them, but I’m glad that I did. Especially since that out of all “Twenty Books” in the “One Volume” I had chosen to copy Book VIII entitled “Sexology.”

Library of Health – Complete Guide to Prevention and Cure of Disease

Edited by B. Frank School, Ph.G, M.D.

Graduate of Jefferson Medical College and Philadephia College of Pharmacy

Table of Contents:

Anatomy, Physiology and Preventive Medicine, Curative Medicine, First Aid Measures, Diagnosis, Nursing, Sexology, Simple Home Remedies, Care of the Teeth, Occupational Diseases, Garden Plant Remedies, Alcohol and Narcotics, Treatment by Fifteen Schools of Medicine, Beauty Culture, Physical Culture, the Science of Breathing and the Dictionary of Drugs. 

Historical Publishing Co.          Philadelphia, PA


In the next few posts, I will summarize some of the wisdom contained in this 108-year-old manuscript. So if you have questions about courtship, matrimony, procreation and more HANG ON! The answers are on the way. 

Part 1 of 4

 

 

Cats 3

Here We Are in 2018

In these almost ten years of cohabitation, I’m unable to find one photo of Zoe and Elliott together. She has never warmed up to him. He has never learned that she likes her personal space. 

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Monetary Liability

I am not exaggerating when I say that the medical care for the two cats combined is a few thousand dollars. Even though I have all the records and receipts I don’t want to know the actual total. I do recall that Elliott’s heart ultrasound was $350 back in 2008 and that his workup last year for a period of lethargy when I thought he was surely terminal was about the same. He was apparently just faking it since all his tests and exams were normal.

These charges are fair and are part of the deal when we take animals into our lives. The total includes annual exams and vaccinations as well as illnesses. Add to that food, litter, treats, toys, brushes, nail trimmers, bathing (Elliott loves his spa days, Zoe not so much) and laser pointers which are so much fun for cat and human and the investment is not insignificant. This fact is important to know before taking on the responsibility of a pet.

Are They Worth It?    

Absolutely, many times over, but if money is tight this may not be the time to adopt a cat (or other pet). 

Hard Decisions 

To the vets’ chagrin, Elliott has continued to gain weight. None of the counseling, handouts or warnings has worked. Not even four pounds when we adopted him, this week he topped the scales at nearly twenty-two pounds. It wasn’t that I did not understand the instructions or the cardiac condition that made being overweight a risk. I did. I do. But when there are two cats who live together and one is skinny and the other obese it is a dilemma. The only way to limit Elliott’s food is to put the cats into separate living areas and that is next to impossible in this space. So, the decision I have made, right or wrong, is quality over quantity.

Elliott was rescued on a railroad track when he was a kitten. There is no way to know how he got there or how he survived long enough to be saved, but he has been happy for all the years since. 

We are lucky that his murmur has not worsened in spite of the weight. He is a big fat happy boy whose heart is full of love. 

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Number 3 of 4

 

Theme photo in title by Kate Puckett Elliott

 

Cats 2

Elliott

Perhaps I should have known something was up when the person who was fostering Elliott insisted that she would deliver him to us in spite of our plans to pick him up. She also discouraged my naming him Zack. She assured me that he knew his name as Elliott. I had thought that Zack and Zoe would be so cute, but I didn’t want to confuse him, so I agreed that he would stay Elliott. As it turned out I don’t think he knew his name for about a year after he came to live with us.

When he was delivered our friends, Mike and Debbie were visiting. I thought the least upsetting for Elliott would be to turn him out of the carrier and into a room where he could be alone without us humans around, so we put him in an upstairs room with food and water and closed the door. In about an hour I checked on him to find that he had chewed or clawed a large piece of trim from the door frame in an attempt to get out. This was just the beginning. 

Dysfunction

When Zoe spotted this stranger in our midst she retreated to the top of our spare refrigerator in the basement. She practically lived in that private loft for the next couple of years. When she did venture down to eat or use the litter box Elliott wasn’t mean to her, but he stalked her. He followed her closely as she scratched and hissed at him. At times she made horrible screaming sounds and at others, she cursed in a low guttural growl. He was just a guy confused by his lack of popularity with this feline housemate. But, Elliott was a lover! He jumped into our laps, he cuddled, he purred. In spite of his concern for Zoe, my husband, Raymond, bonded quickly with Elliott. 

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Within a few days, we took Elliott to the Shelbyville Road Veterinary Clinic to become an established patient where our pets had been cared for about ten years . Unfortunately, the examination revealed that Elliott had a heart murmur. During a later ultrasound, we learned that he had two septal defects, a.k.a. holes in his heart. We were devastated, not knowing what that meant for his long-term survival. The doctors would monitor his condition and advised us to keep him from becoming overweight. 

The Humane Society did the right thing and offered to take Elliott back but it was too late. We loved this cat in spite of all the trouble he brought with him. We were hooked on Elliott. Even Zoe was becoming a little more tolerant even though reclusive. A few years later when we moved to a condo she lost her basement sanctuary and has never been as happy. In fact, she has had a couple of stress-related illness, but she is resilient. She has managed to tolerate this big clumsy roommate for ten years now. 

And, that presents another challenge. Zoe is thin. Elliott is not. Leaving food out all the time is necessary for her, but detrimental to his need to be on a limited calorie diet. So, we continued our dysfunctional ways, loving both cats and trying to provide equal attention and devotion. 

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My Point?

If I have one, I suppose it is that pets are a big responsibility. They require our time and a fair amount of work. They also deserve humans who are knowledgeable about their needs and compatibilities. It is not enough that we care and that we want to rescue at-risk animals. We need to be well informed of their needs. We owe them the same love and devotion they give to us. 

We have done our best to care for both of these cats, but if I am honest I know that Zoe was much happier as an only cat. We didn’t know that at the time we adopted Elliott, so we’ve tried to be responsible to both of them. Now as I care for them alone, I do my best to give them what they need.

The Best Part

We have adapted to the changes in life, a cat added, a smaller home, the loss of a caregiver and we’re still a family. Zoe still curses. Elliott still stalks. But, we have love. 

The cats do yoga with me most mornings. Elliott sleeps with me at night. We have neighbors and relatives who care for them if I need to be away for a few days. I would not take anything for my two cats regardless of the work and expense. They have made my life happier and I trust that is mutual. 

 

Part 2 of 4

 

Theme photo in title by Kate Puckett Elliott

 

The Ritz

Recollections of Travel 

One of my favorite places to stay during my travels was the Ritz-Carlton Pentagon City in Arlington, VA just outside Washington, DC. It was right on the Metro (subway) line and even attached to a first rate shopping mall, not that I had much time to shop while working. I was supposed to be at this venue on 9/11/2001, but two days before I canceled my plans for reasons I do not recall. Others who attended that meeting spent several days getting home because all flights were grounded for days. One of my associates got back home to Florida via train. While I would have been in no danger, I am glad I was not so close to the horrendous disasters of that day.

Before you think I’m bragging about staying at the Ritz-Carlton, I will hasten to add I also stayed at Holiday Inns, La Quinta Suites and once at what must have been a truck stop motel in Bluefield, WV. So West Virginians don’t become offended, let me clarify it was many years ago and I know from a current Google search Bluefield has many nice hotels today. I was in Bluefield briefly to observe an eye operation at the Ophthalmic Center of Excellence. Back to the Ritz story. I was attending a conference, I believe it was sponsored by the North American Transplant Coordinators Organization (NATCO), a group to which I belonged. In the middle of the night before the conference was to begin the next day the fire alarm jolted me out of bed. I grabbed my robe and room key and followed the emergency exit lights. Down many flights of stairs, as the alarm continued to scream, I finally arrived at a door that surprisingly led me straight into the kitchen. Several people who appeared to be employees did not seem in a hurry to evacuate, but the sight that will always remain in my mind is chicken and a few other food items scattered about the floor. Pieces of fried chicken and I distinctly remember kicking a piece aside as I made my way to another door opening into the main lobby.

As I looked about the lobby I saw people looking dazed, some women were wearing fur coats, others were tightly clutching purses and a couple of men had brought their luggage down with them. I felt a bit underdressed, but I was proud of the fact I had followed emergency procedures and left valuables in the room, exiting quickly. Never mind I was wearing terry cloth, had a severely broken nail from the stair rail and no shoes. I wish I could tell you what was on fire, but I do not recall. Obviously, it was nothing significant because the firefighters soon allowed us to return to our rooms. I will never know why I did not encounter other guests on all those flights of stairs or why I ended up in the kitchen with the chicken.

Winding Up

It is time to wind up my recollections of business travel. If only I could remember more details, i.e., dates and exact locations, I don’t think I would ever run out of true stories to share. Of course some, because of confidentiality or intellectual property rights cannot be told. During those twenty-plus years, I visited over one-half of the states in the US and went to Canada three or four times.

The Transplant World

In those many cities, I worked with a diverse collection of people. There were transplant professionals, contract specialists, hospital administrators, lawyers, government and military officials and on very rare occasions a patient or family member. It was a humbling experience because each person had personal gifts, amazing intellect, and made contributions that helped to build not only a strong transplant network but a better and safer approach to life-saving procedures.

When I began my own journey in the transplant world, after a few years developing the immediate care centers, I found each day intriguing whether in the office in Louisville or in some distant city. When the first living liver donor transplant was done in the US, I was present at the hospital where the baby girl received part of her Mom’s liver. Years later, they looked me up and I was so privileged to see this young woman, healthy and ready to enter college. Her donor, (mother), was equally as healthy. Contracts were a challenge, but real people were the inspiration.

Kidney transplants from living donors were first performed in the 1950s and it was about eight years before kidneys from deceased (cadaveric) donors were viable. I became involved at the time heart transplants were first reimbursed by Medicare in the 1980s and one by one other solid organs and even double organs, e.g. heart-lung, were successful particularly after the development of anti-rejection drugs. Bone marrow and stem cell transplantation as better matching has been developed between donor and recipient have developed rapidly as well. I will always find transplantation fascinating. I was never in a clinical transplant role, my expertise in this field was administering benefits , contracting for services and third party reimbursement.

If you would like to know more about solid organ transplantation or becoming an organ donor see the United Network of Organ Sharing (UNOS) at https://www.unos.org

Information regarding bone marrow transplants can be obtained through the National Marrow Donor Program (NMDP) at https://bethematch.org which matches patients and donors internationally.

And, here’s a bonus site for those who love technology. The so-called “heart in a box” is a development by TransMedics, Inc. Check it out here to see a video (<3min.) of the device with a cadaveric heart actually beating prior to being transplanted into the recipient. http://www.transmedics.com/wt/page/ocsheart-improve-tx_med

The company has also developed a similar device for lungs and livers which can allow donor organs to be transported further as well as tested and treated prior to transplantation. There is little doubt that these technologies will extend and improve life for many.    http://www.transmedics.com/wt/page/organ_care

The future is truly now. 

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Thank you for following along with me in my Recollections of Travel. 

 

Photos by Pixabay

 

Deep South

Recollections of Travel 

Traveling in the South was a real treat for many reasons including the soft accents and colloquialisms. I will never forget being in an elevator in Montgomery, AL when a smartly dressed woman walked through the door and requested I “mash 6” for her. I’m sure my mouth was agape while I figured out she wanted me to push the button for the sixth floor! 

Being a Kentuckian, I’ve always wondered why we are considered “southern.” We are far from Montgomery, New Orleans and other southern towns where honeyed accents prevail. In fact, we are squarely in the middle of the Eastern one-third of the US. I know I have an accent, but in my opinion, it is not Southern, but country. I hear it, I’ve been reminded of it and even teased when traveling to cities to the North or out West. I must admit when I was teased I often became, even more country, sprinkling “Y’all” liberally throughout the dialogue. Accents are intriguing.

Charleston, SC

A long time ago a business colleague and I spent a week in Charleston, SC, training staff at one of the ambulatory care centers slated soon to open. It was going to be a demanding schedule which was a shame because by all accounts Charleston was a beautiful historic city. We knew we would have little time for anything other than work but two things were obvious. We had to have a place to stay and we had to eat, so we optimized both requirements. We chose an extra nice hotel situated on the beach and planned to sample the local cuisine at the finest places. 

While I don’t remember every detail of that week, some things do stand out. One was sleeping with the sliding glass doors open to the balcony so I could hear the ocean. The pounding of the waves was magically relaxing after long days of teaching and orienting nurses, doctors, radiology and lab technicians as well as clerical staff. They were experienced professionals but needed to learn the policies and procedures established by our company. 

Seafood

Our treat for the week became the wonderful restaurants, especially those specializing in seafood. Each evening we would choose a different place and linger over dinner while reviewing the events of the day. We were never disappointed in the meals nor the southern hospitality. We tried many types of food, but I kept going back to my favorite, shrimp. I ate shrimp as appetizers and in main courses prepared in various ways. I did not tire of these plump, juicy crustaceans night after night. Clip-art-shrimp

On Thursday night sleep came quickly while I listened to the sounds from the beach. Approximately an hour later, I awoke to severe abdominal pain. It was intense as I sat up and turned on the bedside lamp. Within seconds I was aware of itching of my arms and trunk. The itching intensified to the point that the abdominal pain was almost forgotten. As I called my colleague, Gale, whose room was just down the hall, I saw I had red hives, some as big as my hand, quickly advancing over my trunk and limbs. By the time she got to my room, I was tearing at my skin, unable to control the itching or accompanying panic. Thank goodness, Gale was not only intelligent, she was a “take charge” type who also had Benadryl in her room. I probably owe her my life. She forced me to swallow two capsules of 25 mg. each while she shouted demanding I stop scratching. That was impossible for me as the more vascular areas swelled and throbbed with an itch I didn’t know was possible. 

Hospital

In the city hospital emergency department (ED) those accents I had been enjoying all week, became so pronounced I could barely make out was being said to me. Perhaps it was my state of fear and agitation, but the only person I could understand was the doctor who was from Vietnam! As my lips, tongue, and throat continued to swell I could not believe how chatty he became. He did all the right things obviously because I survived anaphylactic shock, but when he had learned the company I worked for and that I was from Louisville he found those facts far more remarkable than my precarious medical situation. 

You see, this was during the time that the Jarvik 7, an artificial heart engineered to replace an ailing human heart, was being implanted in Louisville, KY.  The surgeon who performed the first such procedure in Utah had moved to Louisville to perform his second and subsequent surgeries at one of the hospitals owned by my employer. The Vietnamese ED physician kept asking questions about that famous surgeon. Did I know him? What was he like? What did the Louisville medical community think of this procedure? If he had known I was recently a nurse manager at the same hospital where this device was being implanted, I doubt he would have been able to focus on his patient at all, i.e., ME! 

Thanks to quick thinking on the part of my colleague and in spite of the ED doctor’s infatuation with the artificial heart surgeon I survived to work another day in Charleston even though it was without sleep. After returning to Louisville tests confirmed I was allergic to crustaceans, e.g. shrimp, lobster, and crabs. I have not eaten shrimp, or any other crustacean, since that trip to lovely South Carolina.shrimp-2393818_1280

For years I grieved the loss of shrimp and lobster. I also went through a stage of blaming myself (called “personalization” by Sheryl Sandberg in her book Option B) for overindulging and thereby becoming sensitized. Finally, I was able to not only accept, but be a little grateful as my research revealed a close kinship between shrimp and certain bugs (arthropods.)


 

NOTE: Allergy to crustaceans is not the same as a shellfish allergy. Oysters, clams, and mussels, for instance, are not crustaceans. For simplification I refer to crustaceans as the ones with antennae. lobster-1538643_1280

Photos by Pixabay

Fashion on the Road

Recollections of Travel

While trying to work in the Delta lounge during a long layover, I was distracted by the TV. It was not loud, in fact, the voice I heard droning on was barely a murmur. Perhaps that is why I could not resist listening to his descriptions of the perfect and perfectly beautiful models sliding onto the show runway. Their hair, flawless, shiny, and straight flowed spontaneously. The make-up was subtle in its goal of looking natural. His sensitive voice was fluid and sophisticated as he described the women. He talked about the models wearing fabrics “sort of blue, sort of yellow and sort of print.” The non-colors were equivocal, there or not there, whatever you wanted. As he proceeded to detail the faces with terms like “the non-lip,” the gaunt women walked up and down, staring into nowhere with eyes that weren’t. 

Later in the week while attending a medical conference at UCLA, I was listening to a distinguished bone marrow transplant physician, world-renowned for his pioneering work with stem cells. As he spoke, the room became absolutely silent while over one-hundred (100) attendees listened in awe to this brilliant scholar describe his latest techniques and accomplishments. 

It was impossible to not notice a movement in the back of the silent room as a woman, too polite to make a distracting click, clack noise with her four-inch heels, walked the full length of the conference room on her tip toes. As she began the trek she looked back and forth, apologetically, at those who observed her progress. She hunched over to appear smaller and assumed an awkward gait resembling a person crippled by some congenital deformity. 

The beautiful woman, hobbled by her stilettos, had broken the mood of academics absorbing knowledge and now we were simply enjoying the show.  

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Photos by Pixabay

Flights Home

Recollections of Travel 

From 1984 through 2005 I traveled nearly every week for work. At first, it was to train clinical staff and open ambulatory care centers (frequently called “Docs in a Box”) in eighteen states. Later, I began Centers of Excellence network development for the same company. Among other things, I contracted for marrow and solid organ transplant services. This position took me to even more destinations including a few times to Canada. In 1997, I incorporated a consulting company still working with transplant centers coast to coast until I reluctantly retired. I believe that I am finally over airport withdrawal but it did take a while. 

During those years of planes, taxis, subways and airports, I made many observations of fellow travelers and others I encountered along the way. I will share some of those recollections that, for some reason, I recall after all these years. Some were intriguing, many more mundane. I’ll let you consider why these memories persisted when so many critical medical and technical facts from those years have evaporated. 

Tampa

While sitting in the airport in Tampa one Friday afternoon, I looked around and noted that almost without exception travelers were either holding or working with a similar small book. Some of these were wire bound, others looked like leather and they came in various sizes. How we loved our Day-Timers back in that day. fullsizeoutput_b02They were badges of our busy lives and demanding careers. One could clearly see that we had a lot to keep up with, places to go and people with which to network. Perhaps few other 20th-century icons made a more important business statement. At that time some kids were using pagers, drug dealers even had mobile phones, but we were reluctant to transition to that digital age back in the 80s, so we proudly carried our Day-Timers everywhere, placed them lovingly into our briefcases and at intervals made critical notes. As I think back to that era, I wish I had saved at least one that recorded a year’s meetings, flights, and appointments. Today we use our smartphones to carry calendars, do banking, prepare and store documents, keep up with e-mail and social media, even monitor or control our homes, but I still recall the small paper pages that functioned on a much more limited basis but seemed equally important at the time.

A man sitting across from me in the waiting area had been dozing off and on. He was dressed in a very finely tailored suit, but the effect was minimized by his splayed legs and occasional snort. One hand was cupped over that bulge between his legs. Was he afraid that someone might steal it if it was not shielded in this manner? When he moved around for a more comfortable position, he changed hands but remained protective. Finally, the flight was called and he awakened, folded his Wall Street Journal and gathered up his leather attache. Standing, he straightened slowly and slightly shook one leg, then the other. Apparently unsuccessful,
he quickly removed the troubling wedgie with a snatch before proceeding down the jetway.
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Atlanta

After a transfer in Atlanta, I’m was finally on the way to Louisville in a much smaller commuter plane. The one busy flight attendant informed us that she was from Columbia and judging from her accent, I assumed that she did not mean South Carolina. Her pre-takeoff instructions included the fact that in an emergency we were to “pull the red liver” to open the door. As we approached Standiford Field (currently Louisville International Airport) for landing the flight attendant’s voice over the speaker gave the following instruction: “If you are enjoying a beverage please pass it to a flight attendant at this time.” So, what do I do if I am not “enjoying” it, but I am simply thirsty, do I keep the cup? I am way too literal to follow instructions tonight.

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Home at Last 

 

Photos by Pixabay

What I Know for Sure 4

The Last Seven

As you may have noticed, this subject has been difficult for me. Quite honestly I am surprised, because I’ve been nothing in life if not sure of my opinions, but therein lies the problem, I believe. Opinions are easy to come by, easy to hold, easy to change. Knowing something for sure is utterly different. Knowing means possessing proof, irrefutable facts, it is a reality, the unwavering truth. This reality is harder to come by. In previous posts, I came up with thirteen (13), if you allow me to include those I threw in facetiously. In order to meet the high bar set by Oprah, in number only, I was determined to come up with seven (7) more things of which I am sure. After much contemplation, here they are:

14. The love of an animal is pure. They give physical comfort, make no demands, don’t pout and are quick to forgive. 

15. Death comes to all living creatures. No matter how we try to avoid this fact it is a reality. 

16. There are no perfect marriages. Some are happier than others, some have more trials, but regardless of the effort put into a marriage, it is not possible to live with another human being without some rough spots and adjustments along the way.

17. White privilege is real. The greatest advantage I’ve been given in life, I have done nothing to earn. It was provided to me at birth simply as a result of having two white parents. 

18. Time spent in nature is rewarding. The sounds of birds, crickets, and water flowing, the feel of breezes that touch one’s face, the glimpse of a small furry animal scurrying along the ground, even the faint fragrance of a wildflower are healing and rejuvenating to the spirit of who we are or were meant to be. 

19. I cannot turn over a new leaf. No matter how many times I try, simply acknowledging that I need to make a change is not incentive enough. For me to make a change, it must involve serious consequences.

20. High heels are detrimental to a woman’s health. Created in Persia (Iran today) to be worn by men riding horses, a raised heel served the practical purpose of keeping the feet within the stirrup. High heels today serve no purpose except to hobble women, making them more vulnerable not only to assault, but to back pain, falls, and injuries to the foot and ankle. Yes, I am aware that they can be beautiful and that women who are strong and agile, can look stunning wearing them, but I maintain that they are not worth the risks involved. 


We have explored and exhausted this subject for now at least. You, the readers, have contributed many things that you know to be true and they are listed below. Please feel free to comment, adding more things you have decided are true over the past month. I believe that something can be true to one of us, yet not all of us. We are individuals and we do not think, feel or believe the same. Thank you so much for sharing with me and with each other. 

What Readers Know for Sure:

I am but a microscopic speck in the great macrocosm of the universe.  
My existence has had a purpose
Life IS worth living
I am a morning person  
I know God is real
A true friend lifts you when you’re down, listens to your problems, is caring and encouraging.
Columbus Day marks the beginning of recorded history in America.
Millions of European migrants came here bringing their music, art, science, medicine and religious principles that shaped the United States.
A leopard can’t change its spots.   
You can’t go back, only forward.
You can’t change the past.
One hand washes the other hand.
You can’t change a person’s thinking when it comes to religion or politics.
What I believe for sure, you may not.
My mother, brothers, and sister have loved me unconditionally.
I have the inner faith and strength to get through very difficult times.
Teachers can change a student for a lifetime.  
Seasons follow each other.
Spring starts from the ground up.
The moon and stars follow the sun. 
Full moons cause strange behavior in people.
Everyone is either predator or prey.
Every action has a reaction.
The human body is the most incredible organism.
Every person has a story.
Every person can choose how to react to their story.
We move through seasons and chapters of our lives individually.
Some decisions are more difficult than others.
When inflated, balloons float up.  
We all die alone, even when others are around us.
We are on this earth as we know it today, only once.

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What I Know for Sure:

I love my family with all my heart.      
Having time alone is a necessity for me.
Native Americans should not be called Indians.
Dish towels should be laundered separately.
April is not delivering in March.   
Love, at first sight, is a real phenomenon. 
Depression should be renamed. 
April had a baby.
Alot is not a word.
I am no Oprah.
CPR does not always work. 
Grandparents are not infallible.   
Adventure Animal Park will continue to make money on April through May. 
The love of an animal is pure.
Death comes to all living creatures.
There are no perfect marriages.
White privilege is real.
Time spent in nature is rewarding.    
I cannot turn over a new leaf.
High heels are detrimental to a woman’s health.   

The flowers bloom, then wither . . . the stars shine and one day become extinct . . . This earth, the sun, the galaxies and even the big universe someday will be destroyed . . . Compared with that, the human life is only a blink, just a little time . . .  In that short time, the people are born, laugh, cry, fight, are injured, feel joy, sadness, hate someone, love someone. All in just a moment. And then, are embraced by the eternal sleep called death.     Virgo Shaka

Part 4 of 4

Theme photo by Akiko Kobayashi (Japan)

What I Know for Sure 2

“No winter lasts forever; no spring skips its turn.” Hal Borland

It has been over two weeks since we began discussing “What I Know for Sure.” To me, this absence of posts is no surprise. After all, there are so few things we know for sure, or perhaps I should say, that “I” know for sure. Your comments after that first installment of this subject were thought provoking and I look forward to you sharing more as we go forward.

Sometimes during the night, when revelations so often materialize, I think, “I must remember this for the blog,” but when morning arrives the thought has vanished. If I am so sure, why did that certainty evaporate with dawn? To me it is further verification we know so little for sure.  Or, perhaps it is that what we know isn’t of great consequence.

Listed below are the four (4) things which I declared, initially, I know for sure. Thank you for not asking me to explain #4! It is one which I feel strongly about and I wonder if you have things which you think too few people know for sure, but should be obvious.

  1. There are few things of which I am 100% sure, but one of those certainties is the fact that I love my family with all my heart.
  2. Having time alone is a necessity for me, but I sometimes forget how much I need to be with people.
  3. Native Americans should not be called Indians.
  4. Dish towels and dish cloths should be laundered separately and not with bath towels or underwear.

What I know for Sure Today

5. April is not delivering in March. That giraffe! Have you been watching? I have, since sometime toward the end of February, and somedays I feel so sorry for her and other days I am mad . . . at her, at the Animal Adventure Park, at her Baby Daddy, Oliver. It is irrational, I know. Nature cannot be rushed. It will happen when the time is right, etc., etc. Last week, on April 8, the park’s veterinarian said that was going to be the day, “April is showing signs of early labor.” NOT! Thousands watched the live cam in anticipation, but no baby. Poor April, gestation for giraffes is fifteen months and the offspring will weigh around 150 pounds. April has gone through this three (3) times before. She knows what she is doing. It’s the caregivers who apparently do not. 

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6. Love at first sight is a real phenomenon. Not romantic love, I don’t know about that, but a Mother’s love for her newborn. No matter how red, skinny or fat. No matter how covered with toothpaste-looking vernix caseosa, bald or not, a Mom is going to experience pure love the moment she looks at her newborn’s face.

7. Depression should be renamed.  Depression is a word from the late Middle ages meaning to “press down”. It evokes a slump or perhaps an indentation, nothing too significant. The word may refer to the economy (recession), weather (tropical) or to geography (relative to the horizon). It also is a medical diagnosis and this is what should change in order to more adequately portray the condition. In the Diagnostic and Statistical Manual (DSM) of Mental Disorders there are several diagnostic codes listed for variations of this disorder. It is not my intent to delve into the nuances of this diagnosis which can be complex and even terminal, but to encourage thought and perhaps dialog.

Too often, this diagnosis is considered to be a temporary “down” feeling which will pass, but in fact it is more likely to be a permanent condition that varies in intensity. If you struggle to understand friends or family members who you know to be depressed, please read this short account by John Pavolvitz, one of my favorite bloggers. I had been following Pavolvitz’s posts for over a year without knowing he suffers from depression, until reading this one:  http://johnpavlovitz.com/2016/07/05/the-privilege-of-mental-health/

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Photo Credit: Missy Cornish

As Borland’s quote at the beginning of this post, some things are a surety and they bring comfort. It is reassuring to know spring never misses its turn and no night lasts forever. As one of our readers has stated, “. . . . . the Sun always rises. Light transforms the darkness.” And, while this is true there are those who suffer from “clinical depression” who cannot know this for sure, everyday. No matter what we call depression, it is a diagnosis to be taken seriously, to be treated and to be better understood. That understanding brings light to sufferers.

Part 2 of 4

Theme photo by Akiko Kobayashi (Japan)

Death – Suicide

“Suicide occurs, not because the deceased was selfish or because their loved ones failed them. Suicide occurs when one’s pain outweighs their resources of strength.” 

rocky-shore

Suicide

After our first discussion of Death back in mid-January, one reader stated: “Perhaps it is the way a person dies (long illness, accident, suicide, etc. ) that shakes our world more than the actual act of death itself? ” I agree with that assessment. While permanently saying goodbye to a person we love is always unbearably painful, it seems some losses are harder to accept than others. One of those circumstances is suicide. 

The very word “suicide” brings on so many questions; the first, of course, is “why”. There are many factors that contribute to the act of suicide, but rarely is it one event or situation resulting in an individual ending their own life. There may be a trigger, but the reason is much more complicated than one incident. Seldom is suicide chosen without being preceded by a long struggle, often accompanied by chronic depression. For some the desire to die is such a strong compulsion there reaches a point where it can no longer be denied. 

When I worked as a RN in an Emergency Department many years ago I witnessed firsthand the victims of suicide, some successful and others who were not. I saw the shock, confusion and heartbreak of families and regretfully at least one doctor who could not understand nor empathize with such a patient. I recall the horror of working on self-inflicted gunshot wounds, pumping stomachs to remove poisons and overdoses and witnessing myriad other ways in which people took their own lives. I never doubted that they were serious, although there were one or two who I thought might have been too immature to fully understand their actions. Many patients were saved, some were not. I recall one man who had shot himself and survived who wept and confided, “I can’t do anything right.” I will never forget his sorrow at being unsuccessful. I’m sharing these few details of that hospital environment to demonstrate that suicide is not an act for attention, but an act of desperation. 

Incidence

According to the World Health Organization (WHO) suicide occurs globally every 40 seconds. This translates, tragically, to the loss of 2,160 lives each day. In the US in 2014 (the last year for which there are complete statistics) suicide was the tenth leading cause of death and claimed the lives of over 42,000 people according to the Center for Disease Control and Prevention (CDC). Perhaps more disturbing, the suicide rate over the past fifteen years has increased by 24%. 

Eulogy for a Mom

There is so much that can be said on this subject. Sadly most of us have some experience with the heartbreak associated with a friend or loved one ending their own life. Perhaps you have undergone a close or recent loss due to suicide. Aside from listing some resources at the end of this post I feel the most helpful thing to do is to share with you a eulogy I was honored to hear at a memorial service in December of 2014. 

This eulogy was given by the daughter of my neighbor and friend, Marilyn Lamb. Marilyn’s daughter, Laurie Lamb Ray, has graciously given her permission for this tribute to her Mom to be reproduced here. Laurie’s words lovingly and sensitively state what we need to hear and understand when one dies as the result of suicide. I believe you will find it enlightening and that it will be helpful if you have the opportunity to comfort someone who has lost a loved one under these circumstances. 


Here are Laurie’s words:

I know you expect me to talk about mom tonight, maybe share funny foibles, touching tributes. And, I could. I have hundreds to share. But, I’ll leave that to others. Today, I’m going to talk about the elephant in the room. And, the elephant in the room is suicide. And now that you know I’m going to talk about suicide, I know that you are terribly uncomfortable and would like nothing better than to get up, jump in your car and go home. But you are a captive audience so, in honor of my mom, I’m going to ask you to stay and I’m going use this opportunity to try and help you understand my mom and her suicide.

Yes, my mom committed suicide. And we are all horrified and shocked and so very sad. And, let’s face it, even if we try really hard not to, we all tend to judge her just a little bit. Even the words we use seem a little damning, don’t they? She committed suicide. As if it is a crime akin to murder. We say, How could she do this? To me, to all of us? How selfish. How awful. How could she? And we are puzzled. She looked fine to me. She seemed fine when I saw her at the party just the night before. Well, don’t feel bad, she seemed fine at the party to me too.

But, you see she wasn’t fine; hadn’t been fine for my entire life. My mom had severe chronic depression. I don’t know how many of you know someone with severe chronic depression, but I know all of you have known someone who died of cancer…they fought it, they wanted desperately to live, they took medicine, sought help, people prayed for them and “yes” sometimes they even seemed fine. Yet, at some point they could no longer fight – they had become too weary, too weak and they just could not continue to live. And, that you see is exactly what happened to my mom. 

My mom died from a chemical imbalance in her brain. Not a weakness, not selfishness, not a sin against God. A very real, physical imbalance that left her unable to cope and unable to hope for things to get better.

So many of you have asked what you can do to help during this time. I’ll tell you what you can do. In memory of my mom, I ask that you re-file “suicide” from that place in your brain that judges and is horrified, to a place where there is nothing, but compassion and understanding. 

Your mom died of cancer? Well, my mom died of chronic depression. And, today she is no longer hopeless. She is with my dad and, even in the midst of my sadness, THAT has to make me smile.

Mom, I understand and I love you.


Thank you Laurie for sharing with us. We are grateful for your kindness and generosity. I would also like to thank Laurie’s Aunt Janet, who graciously agreed to share this message concerning her sister’s death. 


 

The following signs, symptoms and risk factors are from: https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

Signs & Symptoms

The behaviors listed below may be signs that someone is thinking about suicide.

1.  Talking about wanting to die or wanting to kill themselves

2.  Talking about feeling empty, hopeless, or having no reason to live

3.  Making a plan or looking for a way to kill themselves, such as searching online, stockpiling pills, or buying a gun

4.  Talking about great guilt or shame

5.  Talking about feeling trapped or feeling that there are no solutions

6.  Feeling unbearable pain (emotional pain or physical pain)

7.  Talking about being a burden to others

8.  Using alcohol or drugs more often

9.  Acting anxious or agitated

10. Withdrawing from family and friends

11. Changing eating and/or sleeping habits

12. Showing rage or talking about seeking revenge

13. Taking great risks that could lead to death, such as driving extremely fast

14. Talking or thinking about death often

15. Displaying extreme mood swings, suddenly changing from very sad to very calm or happy

16. Giving away important possessions

17. Saying goodbye to friends and family

18. Putting affairs in order, making a will

(Blogger’s note: It is conceivable there are some victims who do not display outward signs prior to suicide.)

Risk Factors 

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex and there is no single cause. In fact, many different factors contribute to someone making a suicide attempt. But people most at risk tend to share certain characteristics. The main risk factors for suicide are:

1.  Depression, other mental disorders, or substance abuse disorder

2.  Certain medical conditions

3.  Chronic pain

4.  A prior suicide attempt

5.  Family history of a mental disorder or substance abuse

6.  Family history of suicide

7.  Family violence, including physical or sexual abuse

8.  Having guns or other firearms in the home

9.  Having recently been released from prison or jail

10. Being exposed to others’ suicidal behavior, such as that of family members, peers, or celebrities

Many people have some of these risk factors, but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored.


If you need help:

Contact the National Suicide Prevention Lifeline

Available 24 Hours a day, 7 days a week.
The service is free, confidential and available to anyone.
All calls are confidential.
You’ll be connected to a skilled, trained counselor in your area.

Call 1-800-273-TALK (1-800-273-8255) or
Use the online Lifeline Crisis Chat: https://suicidepreventionlifeline.org

For more information, Visit the National Suicide Prevention Lifeline

(the source of this contact information)

 

 

Death-Hospice

Follow Up

To follow up on important topics from the last post in this series, please read the comments left by “Lula.” Remember that little black bubble at the end of each post?  fullsizeoutput_9edJust click the bubble on Death Decisions (Jan. 25, 2017) to read the important information she has shared with us. 

Lula shared interesting information about a service which sounds like a good idea for anyone, but especially those who travel often. I am not familiar with Living Will Registry, but you can read about Lula’s own experience as a frequent traveler (in her comments) as well as reviewing the service Online.*

One issue that Lula mentioned is Emergency Medical Services (EMS), when called to a home, will likely begin CardioPulmonary Resuscitation (CPR), even if one has a Do Not Resuscitate (DNR) order on a Living Will. I have always heard the same thing, but an official form** in this state (KY) is meant to address this problem. You should check with your own state, city and/or county for the law where you live. Regardless of one’s current health status it would be helpful to fully understand the guidelines before a need arises. It is understandable this is a potential for problems. The very fact EMS is called indicates an emergency and they come prepared to do what is necessary to save lives. If one has a terminal condition CPR is not likely an appropriate response, but it is unfair to expect emergency personnel to make that distinction or take that responsibility. 

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Hospice

Having Hospice involved in end-of-life care can often prevent such situations from occurring. Hospice is a national organization with local offices across the US, providing palliative care to patients facing advanced illnesses and to their families. Palliative care involves relieving pain and enhancing quality of life (as opposed to addressing a cause and/or cure) and may be provided in the home, special centers, extended care facilities or special units within an acute care hospital.

When Hospice care began gradually in the US, during the second half of the Twentieth Century,  there were specific parameters regarding how long a patient was expected to live in order to be admitted into palliative care. Although this is no longer the case, it is a lingering belief and can make it hard for families to approach the subject. I personally feel Hospice is extremely valuable in providing clinical, pastoral and grief support as well as practical assistance with medical supplies, equipment and even volunteer and respite care. Extensive information is available from National Hospice & Palliative Care Organization*** (NHPCO).

Possibly many of you used Hospice services for your family or maybe a close friend and I invite you to share your experience with us if you are comfortable doing so. I will share that in my experience with loved ones the service was not instituted soon enough. In one case, incredulously, it was not possible to get the physician to admit the patient was dying and by the time a referral was made the patient only lived a few hours. The other personal case was just the opposite. The physician recommended, even urged, Hospice service, but the patient wanted to wait a little longer, not realizing the time would approach as quickly as it, in fact, did. In each case the patient did not receive care that would have perhaps eased their passing. I painfully share this hoping it might prevent others from waiting too long. 


Websites referenced:

*Living Will Registry http://www.alwr.com

**KY DNR Form http://manuals.sp.chfs.ky.gov/Resources/sopFormsLibrary/Do%20Not%20Resuscitate%20Form.pdf

***NHPCO http://www.nhpco.org


Coming Up

We will look at Funeral and Burial Planning in the next post. I realize this may be a bit too pushy, but if you are so inclined how about working on writing your own Obituary before then? Then we will work together. Your participation is great and makes our experience together so much richer. Thank you!


“I find it delightful that the optimal way I can live my life from moment-to-moment is also the optimal way I can prepare for my death, and equally delightful that acknowledging our future death is a prerequisite for living a truly joyful life now.”  Ram Dass, Still Here

Death – Decisions

Decisions

It is understood that family units are all different and may be made up of biological or chosen family, spouses or partners, relatives or close friends. We will use the term “family” for those closest to you. These differences may dictate what, exactly, you need to do to from a practical standpoint to prepare for your death, but regardless, the first step should be honest family discussion. We’ll call it “The Talk.”

The Talk

It doesn’t have to be a formal meeting. If you and your family are open to the discussion of death “The Talk” can be in increments and flow from normal conversations. When discussing the death of an acquaintance it is a natural time to say, “When I die, I prefer . .” Since such discussions may not include everyone who needs to hear, having your wishes in writing, leaves no doubt or confusion. So, what do you need to talk about and how will you document it?

Living Will

Legal agreements can be our guides. Let’s start with those things usually addressed in a Living Will. If you are diagnosed as terminal and are no longer able to make your own decisions, because you are permanently unconscious or otherwise unable to express your wishes:

  1. Do you want treatment withdrawn except for pain control?
  2. Does that include withdrawal of food, water?
  3. What about a DNR (do not resuscitate) order?
  4. Do you wish to participate in anatomical donation?

Decisions for #1-#3 can be very difficult for a family member. You may have no doubt that these life prolonging actions are inappropriate or undesirable for you, but to your loved one it is not that clear. To them it may feel as they are hastening your death, while you are more likely to feel that such measures would prolong suffering. If this has been discussed and documented ahead of time, there is less anxiety when the decisions must be put into practice. Physicians, emergency personnel and hospitals must provide every means available to save a life if they have not been given the legal right to withhold those interventions. Resuscitation (CPR) will be initiated, regardless of the patient’s prognosis, unless there is an order in place for DNR.

Number four (#4) involves whether you would like to donate organs for transplantation or all of your body to science. If donating the entire body is your desire, besides documenting, it is best to make logistical arrangements in advance. Most such donations are made through a university or medical school.

Organ donation decisions are often made long before formal end of life planning. In most states one can designate the wish to be an organ donor while obtaining or renewing a driver’s license. Organ donation more specifically is addressed in the Living Will. If you have explicit wishes, maybe you are willing to donate corneas, but not hands for example, this needs to be legally documented. On this subject people often think first of heart or kidney, organs which dramatically save lives. In fact, donations may be made of tissues such as skin which is used as dressings for severely burned patients or bone for spinal surgery. There may be personal or practical reasons for specifying exactly which organs/tissues you are willing to donate and these can be itemized in your Living Will.

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Consider Donation of Organs or Tissue

Transplantation is a subject that I feel strongly about, having worked in that field for many years. I find it unfortunate that after over sixty years of successful transplantation, only 52% in the US choose to donate. If you have not already made your decision, please give some consideration to it now. There is no lack of information available to answer any questions you may have. I recommend calling your local/state donor affiliate or researching Online.

The United Network of Organ Sharing (UNOS) is the national organization which governs transplant facilities and Organ Procurement Organizations (OPO) in the United States. Their website probably contains more information than you would ever need: https://www.unos.org

Cornea transplantation differs in some ways from other donation and a good site for more information is https://www.donatelife.net/types-of-donation/cornea-donation/

Bone marrow and stem cell transplantation is still in the experimental phase for cadaveric donation, but is showing promise. If you are interested you may find information at the National Marrow Donor Program: https://bethematch.org

Your Surrogate

A Living Will allows one to record legally, exactly what one wants and does not want. Or, with this document you can authorize a HEALTH CARE SURROGATE, sometime referred to as a proxy or Medical Power of Attorney (POA), to make these determinations for you at the time of need.

Choosing a Health Care Surrogate is a very critical decision. First, of course, is that it be a person you trust. Your designated surrogate should be geographically close if at all possible and should know your wishes before accepting this responsibility. A few of the subjects included in a legal Surrogate Designation are:

  1. Access to your medical record
  2. Right to choose your health care providers and long term facilities
  3. Withdrawal of life-prolonging treatment

This legal document names your surrogate and an alternate surrogate in the event the first person designated is unable or unwilling to serve at the time she/he is needed.

Update and Storage of Documents

Sometimes we change our minds about the directions we’ve given and the Living Will and/or Surrogate Designation may require legal revision. These documents need to be reviewed on a regular basis. If our wishes remain the same, it is probably advisable to initial and date each page to show that they remain current. Having your Living Will on file at your hospital can make it difficult to keep current. I would trust a photocopy carried by my surrogate (and in my car’s glove box) more than the hospital’s computer system. It goes without saying that original documents need to be stored in a locked fireproof box and that your surrogate and/or POA has access.


“It seems to me most strange that men should fear; Seeing that death, a necessary end,  Will come when it will come”  Shakespeare in Julius Caesar

Death – Intro II

Introduction II

As we move forward discussing the topic of death and end of life decisions, in particular, I refer you back to this blog’s first page, HOME. At the bottom is a disclaimer and it is important that you review it at now, particularly this:

The content of this blog is not intended as advice . . . . Information contained herein is not presented as medical, legal or clinical recommendation . . . .”

And, I would add:

  1. It is extremely advisable to seek legal counsel from an attorney for estate/end of life planning.
  2. Forms are available Online for your review (or printing), but I caution you to use either the US Government (https://www.usa.gov/federal-agencies/a) or (https://www.irs.gov/forms-pubs), your State Government (state laws differ) or the American Bar Association (http://www.americanbar.org/groups/real_  property_trust_estate/resources/estate_planning/living_wills_health_care_proxiesadvance_health_care_directives.html) Websites. Using these sites one can avoid ads and scams.

The kind of end of life decisions we will focus on are sometimes included during estate planning which deals with financial issues. Money management is not part of our discussion.


Future Posts

In the next few posts we will discuss the following topics, some more in depth than others:

  • Power of Attorney (POA)
  • Living Wills
  • Health Care Surrogate/Proxy
  • Organ Donation
  • DNR (do not resuscitate) orders

Other topics in the future will include: Funerals, Obituaries, Grief and Suicide.

In the last post I asked you to say the words: “When I die” and to acknowledge we are born terminal. Some of you responded with your thoughts and experiences and I appreciate your honesty and willingness to share. It is not surprising there are those who are not ready to talk about such personal feelings. Discussing death is difficult in varying degrees based upon our past experiences and other factors, e.g., religion, age, health status. It was reassuring some of you have already taken formal steps to inform others of your wishes at the time of your death.

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Reader Feedback

Marybeth, while sharing that her parents were very organized in having preparations in place for death, also stated, “Perhaps it is the way a person dies (long illness, accident, suicide, etc. ) that shakes our world more than the actual act of death itself? ” This is a valid observation, because while losing a person one loves will always be painful, there are many variables which affect how we react and how we grieve.

Rita discussed the awe of her own conception which is the beginning of the brief interlude we have on this planet. We often hear “cradle to grave,” which sums it up.

Finally, Lula shared the preparation she has made for her own death having had that responsibility for deceased loved ones. Such experiences in dealing with the estates and last wishes of others certainly point out the value of thinking ahead and making the decisions we are about to discuss.

Thank you to each of you who shared.

With the next post we will begin discussing the person (proxy) who makes medical decisions for you when you are unable to express your wishes. That person may be designated in a Medical POA, a Living Will and/or Designation of Health Care Surrogate.

“Life cannot exist without death; neither can death exist with life.” Osho Rajnish


Past Problems with the COMMENT Section

Some have expressed frustration with trying to comment on posts. I understand and I admit it isn’t easy to figure out and I’ve made some changes AND mistakes along the way. To comment on any post click the little bubble below and right on this page. If yours is the first comment that little black bubble will have a + sign on it. If others have already commented there will be a number in the bubble. Either way, all you have to do is click the bubble and a space will be provided on which to write.

Here is a screen shot from my phone that shows the illusive “bubble.”

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Thanks again!