Changing of Seasons and Noticing.. Today is Halloween and the weather is cloudy and warm for this time of year (in the 60’s).  Yet mother nature isn’t disappointing us and the belated beauty of the autumn foliage is spectacular.  My husband made a point of alerting me to the brilliant reds and oranges on our backyard maple tree, particularly as contrasted with the golden yellow of the trees behind it.  And as we watch the leaves fall to the ground, and, perhaps, complain too much about our need for raking, I am reminded of the seasons of life and the theme of noticing.

Autumn happens to be my favorite season as I welcome the lower humidity (as experienced on the East Coast), cooler and crisp days, weather that beckons you to play outside and ride bikes or go for hikes.  And every time I mention my favorite season of autumn to others, they mention the regret of shorter days and the coming of winter.  The coach in me forever searches for another meaning… another perspective and the metaphor hiding beneath the surface.

In our American culture, is it that we resist death, as in the falling of leaves, because of perceived darkness to come?  How might we use the sharpness of light and color, and noticing that is inspired within us just before the falling?  How often is it that when we recognize the impermanence of something or someone, we seem to notice what’s special about them and cherish them more?  As you know, I am taking care of my elderly mom and I marvel at how I can still find those sparks of beauty and strength, amidst the decline of her memory and her independence.

The leaves that are dying stand out against the perpetual green of the evergreens, and those trees become background to the display of color and life that seems to come to the deciduous trees.  If only we could recognize that beauty in our aging seniors and celebrate them as we celebrate autumn splendor?  If only we could use our powers to pause and notice in seasons other than autumn?  Nature has so much to teach us and each season brings a unique beauty and message.  Winter teaches us to slow down; conserve energy; stay warm, and turn inward.  We are preparing for the burst of energy and outward focus of spring, with new hopes, dreams, growth, and splendor.  Using that burst of energy, we go full throttle into the longer days of summer, filled with activity, adventure, lightness, sunshine, laughter, and play.  Just imagine if we had to keep that up all year long?  What difference would that make to our ability to pause and notice?  Now there’s something to ponder!  Are we creating a perpetual summer with our constant use of electronic devices? (I’ll save that for another passage!).

I’ve been finding it more difficult to wake up in the mornings and I am reminded of nature’s slowing down and hibernation. I am choosing to continue to celebrate the beauty of autumn, yet I am celebrating it for a whole new reason.  I am celebrating my ability to notice.  After seeing a photograph that I took during one of our hikes, a friend of mine commented: “Joy, you see things that others don’t see:  what an eye you have!”  God has certainly blessed me with that ability and I celebrate it not only with photography, but more-so with nature and people.  Here’s to noticing and to the seasons of life!

We Get It!
To all my friends who have children.. to all the moms and dads...  We get it!
My husband and I were not blessed, and ultimately chose to not have children.  Whenever people would ask us if we had kids, which happens very often when you first meet someone, we would respond: "We have cats!"  It almost felt like we had to say something to make us feel "OK" about our response. During the years when I struggled with infertility, I would often ask God: "why?"  "What is the reason we're going through this?"  Like there had to be some rational reason for our life circumstance... life is fair, right?... NOT!

As you may know from reading other blogs, we became the primary caretaker for my mom, who suffers from dementia.  Eighteen months later, my mother-in-law has also come to live at the same continuing care community as my mom.  We have our family wagon (see prior post), and we are now experiencing what we imagine you parents have experienced for most of your lives.  We now get it!

• We get that a planned and orderly day is a day of the past.  That we are at the whim of whatever crisis may occur, be it medical, emotional, something lost, something found.  At any moment, we give up what was planned for what now is.

• We get that we can no longer judge our moms'/ children's behavior according to "adult standards."  Saying: "don't you remember?," or "you should remember..." is pointless.  Instead of frustration, we seize the opportunity to be present and "in the moment" with our moms, recognizing that, in physical form,  they aren't always going to be with us.

• We get that discussing bodily functions is a frequent occurrence.  That hearing in-depth descriptors of bowel movements and incontinence is now considered daily subjects for conversations.  We get that sometimes, our trips do need to be planned with bathroom stops as key activities.

• We get that, when they're in pain, we're in pain:  That there can be nothing that tears you apart more than seeing people you love suffer and knowing there's little you can do about preventing it from happening.

• We get that there are these precious moments, that if we could only package and keep in some easily retrievable form, would provide us contentment for a lifetime!  Like being a silent observer, watching my mom participate in a ballroom dance class;  or sharing in her "joy" when she hears a song from "My Fair Lady" for the 100th time, yet seems to enjoy it as if she was hearing it for the first time!; or when she takes my hand and tells me: "you'll always be my youngest daughter and I'll always love you."  Funny, it doesn't seem to matter how often I hear that!


• We get that spending money on ourselves without thinking about having "enough" to take care of our moms is now in the past.  It's no longer about me/ or us as a couple.  We have others who are dependent on us and that impacts our perspective on money, on travel, on with whom we entrust their care, and on our taking care of ourselves.  Taking risks is far less of an option....  we need to stay well so that we can take care of our moms.

• We get that there is nothing that can lift us up as quickly as buying something for our moms that cause their eyes to light up, and makes them feel special and loved.  And, we also recognize that we don't have to buy them something: it's our making them feel special by being with them; by touching them in a loving, compassionate way; by helping them to know that they matter; they are not invisible, as our society would sometimes prefer our elders to be; and that they still have a purpose on this planet.  Our parents are always our parents, just as our children are always our children, regardless of how they may tower over us, or be shrunken by bones compressed due to gravity and weaker muscles.  

• And, we get that when they are gone,  we will miss them and they will leave a hole in our heart that can never be replaced.

At the ripe young age of 54, I just bought a family wagon!  Normally, when I think of family wagons, I think of car seats for infants and toddlers; hauling children back and forth from athletic events; taking the dog for a ride; packing bags of groceries to feed the gang at home; and driving our adolescents and their friends to the mall or some other social gathering.

But, my husband and I don't have a dog... we have two cats who don't particularly like to ride in the car; we don't have children and the groceries we buy, for the most part, are just for the two of us.  So, why the family wagon?  Thankfully, we have aging mothers!

Now we pack walkers (rollators) that allow our moms to sit when they get tired, and keep them balanced when they walk.  We may buy them groceries, but they're limited due to the meals they get at their continuing care community.  We haul them to various events... alas, most of them seem to be doctor's appointments. We crank up the volume on the radio but it's not so they can sing along and groove to the beat... it's so they can HEAR any beats!

The music we play is not of our time.... it's of THEIR time... We don't talk about the news of today; we reminisce about days gone by and speak more of emotion than facts.  Head matters less..... heart matters most. We exchange "I love you's" at every encounter and offer hugs as if they may be our last one, because they could be.  

I have the privilege of watching my husband demonstrate patience (most of the time...), advocacy, and compassion for our moms and I fall in love with him all over again.  Both Robin and I are learning to be less judgmental and more accepting; to exercise our sense of humor and the art of forgiveness.  We are parents at a mature age and thank God every day that we can give back to our moms who have given us so much!  On this day of Independence, we are thankful for our freedoms and for those who are dependent on us.  God Bless........ 

Robin Goldman and I got some discouraging news yesterday with his angiogram and I decided to post a question on the AVM Survivor's Network to tap in to their collective courage and wisdom. The wise response back from "Ron" are words that can benefit all of us..... As Robin and I continue to travel this road, we are so very thankful for the angels that appear in our midst... like my friend, Evelyn who came down to the waiting room yesterday and cried with me as we heard news; or the person I've never met who came over to me and handed me rosary beads..... and my friend Susan M. Hahn who was there with us and will be there on Monday to meet with the doctor.... there are blessings amidst the pain, if we choose to look for them.... And, for Robin and I, as they say..... "it's not over 'til it's over!"

Thanks, Ron!.........

"Sorry no experience in cortical venous drainage.

As far as encouraging words, I've watched my wife go into brain surgery about 10 times (counting embolizations) and my son twice to stop seizures. It is not a fun journey, but for us, everything came out well. I wish the same for you!

I would encourage you to cherish every hour of every day. Forget about cleaning the house or doing laundry (hire someone if you can, or just ignore it). As much as you can, go and do things that are fun. If you enjoy reading, read all the encouraging books you can find. Be a joy to those around you, in any way that you can.

Give your friends and family that want to help you specific things they can do. They are hurting too, and any tasks they can lift from you helps YOU and THEM as well.

Give yourself permission not to hang around negative people (even if they are family). Turn off the news. We joke with our kids that we bought a new tv to watch Gun Smoke in hi def!

Laugh everyday, or every hour.

I am reminded of a saying I read in one of the Chicken Soup of the Soul books: "If you found out you only had an hour to live, who would you call, what would you say, ............ and what are you waiting for???????????????" Not meaning this as a downer thought, just a call to action.

Make a bucket list and start. Not suggesting round the world trips. Heck it might be 'go to dinner and a movie'.

I hope this helps and I wish you the best,
Ron, KS"

Recently, I've been putting much thought into the impact of "expertise" in healthcare.  As a leadership and physician leadership coach, I very often work with my clients on their habit of problem solving, knowing "the" right answer, judgment, and intellect. 

In my personal journey in dealing with my husband's life-threatening brain disorder, I find myself torn between wanting to look to my physicians for "expertise" and "hope," while also being aware of the limitations of medicine and my need to define my own reality... my own story.

It is an interesting perspective to be a consumer of healthcare and practitioner within healthcare at the same time.  I've been reading, with avid interest, the differences between the medical model and patient-centered model, as defined within "Escape Fire's" movie and facebook page (that is where all the "expert information" is, right??). As the authors describe, the patient-centered model  requires a shift from "physician dominant," to "physician collaborates:"  From "care is disease-centered," to "care is quality of life centered;"  From "physician does most of the talking" to "physician listens more and talks less." 

As I read various related literature, like "The Four Habits" that was created by the great folks at Kaiser Permanente, I think about tools that help shift this paradigm.  As they describe,  The Four Habits are: Invest in the Beginning, Elicit the Patient's Perspective, Demonstrate Empathy, and Invest in the End. The goals of the Four Habits are to establish rapport and build trust rapidly, facilitate the effective exchange of information, demonstrate caring and concern, and increase the likelihood of adherence and positive health outcomes.  What I find fascinating about this model is that it parallels the framework of a coaching model perfectly! 

In coaching, the client is the expert, holding all the wisdom, strength and courage that a capable, wise, and powerful being possesses.  A table succinctly describes the four habits and associated skills:  "elicit patient concerns;" "ask for the patient's ideas;" "be open to patient's emotions;" and in "investing in the end," "deliver education and diagnostic information and then involve the patient in the decision making process."  It reminds me of a dance that is more of an interplay between leader and follower with those roles being flexible and dynamic, rather than fixed and unchanging.

All of this requires a perspective that is quite different from doctor, or nurse, or any other discipline as "expert."  It requires a vulnerability that allows us to say: "I don't know everything" and most importantly, I don't know what matters most to my patient.  Therefore, while my breath and depth of knowledge is vital, I'm also a learner along this journey of wellness with my patient/ client.  Now there's a thought!  What impact would it make if we were to start labeling the "patient" "client?"  Better yet, how about "health partner?"  Whatever term would convey the essence of each individual's wisdom and insight to direct their own health, and their own wellness, even if that includes dying.

There are two resources I use repeatedly in my work with clients: Marilee Adams' "Change Your Questions, Change Your Life," and David Emerald's "The Power of TED."  Ms. Adams describes her simple, yet powerful "Choice Map," which helps the reader consider a shift in perspective from judger to learner.  It requires us to recognize when we are making judgments about others (which she describes as landing us in the pits) and intentionally shifting that perspective to one of learning and desired outcomes.  It's less about blame and who's right or wrong, and more of "what do we want, what assumptions am I making, and what are the options open to us?"

Mr. Emerald describes the empowerment dynamic as moving from victim to creator.  As a creator, I have choices in how I deal with life's challenges, and I can seek the help of coaches who can appropriately challenge me to discover my wisdom and help me move toward health and success.

Can we make that shift in healthcare?  Can we use our great strength in problem solving and science/ medicine, while also making room for art in more fully engaging our health partner on their journey to wellness?  Can we notice and abandon our own egos and judgments, in service to the patient?  I, for one, would love to be part of that journey!

I welcome your perspective!