TRANSITION: Nearing Death Awareness

Grief Work usually refers to the survivor’s efforts to rebuild, to create a new normal. At Adagio until Grace’s passing we also used the term Grief Work to refer to our participation in our resident’s passage from life to death.

Two Hospice nurses have coined the phrase “Nearing Death Awareness” to describe the stations a dying person travels through to achieve the end of the line. We adopted this change in verbiage as we become aware of Grace’s transition points, gestures, statements, visions. 

A friend gave me the book Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley. They write “As nurses who care for the dying, we see ourselves as the counterparts of birthing coaches or midwives, who assist in bringing life from the womb into the world. At the other end of life, we help to ease the transition from life through death to whatever exists beyond.”  Our goal is to help our dying residents achieve comfort, peace and perhaps even joy.

Callanan and Kelley affirmed us with case studies describing similar experiences to our own. Each of our residents have reported or reacted to seeing loved ones who had died before them, a brother, mother, friend. Some would call this vision a hallucination. I was uncertain, but now am open to the possibility that they were met by important, caring people. These visions brought them comfort that they would not make the crossing alone. I leave it at that.

With our first near death experience I thought our work was the respect we owed someone who had contributed much to family, church, country during his life. I have since learned that expressing appreciation for and confirmation of their life was probably heard since hearing is the last sense to go. Speaking his name, the names of family members, organizations, assuring him that he had done well, he had been a good and faithful servant. He could let go. Speaking his name and assuring him, a confessing believer, that God knew his name and loved him slowed his breathing and I could visibly see him relax. Singing his favorite song in the emergency room calmed him into acceptance of the nursing staff’s physical ministrations.

My husband and I had learned through the years that people may be hanging on until their family gave them permission to “go home.”  They were fearful that they were abandoning their obligations. They may be struggling against death until a family member reunited with them and spoke of their love and perhaps forgiveness. Final Gifts affirmed that experience.

Our dying residents are not our only concern. Their families come in all stages of preparation and acceptance.

 “Patient and family exist as a unit—interacting and struggling together in what can become a perplexing maze of distress and anxiety. The solution to this maze requires attentiveness and willingness to listen and understand.” (Page 28)

Thank you to the Hospice professionals who have attended us at Adagio. Nearing Death Awareness…work we all will come to do at the given time.

From the Land of the Living

Several of you emailed valued responses and questions to my comment on "Patience" in my tribute to Grace. But like anxiety, patience requires research and hard thinking. I need a break from grief work.

An important aspect of living is eating. Last week we feasted on nectarines and the leftovers with berries became a free form tart.

This week we have enjoyed fresh peaches, but a few were developing brown spots. Time to bring out the church cookbooks. Thanks to our friend, Leona Van Sant, we have a copy of the 100^th Anniversary Cookbook, I Reformed Church, Sully IA.  I began with the Fruit Crisp contributed by Kelly Zegers. We then developed our own concoction based on the standard oatmeal and yellow cake mix.

We welcome any variations or contributions you care to make. Perhaps we should offer a contest: the winner does not receive a snail mail package of our yellow, week-old broccoli.

Fruit Crisp

5 Tablespoons butter, melted

1 Tablespoon flour
1 cup brown sugar
1½ cup oatmeal
1 can fruit pie filling: apple, cherry, or peach

Place pie filling in bottom of 8X8-inch pan. Mix first 5 ingredients together and crumble over pie filling. Bake at 350° for 30 minutes.

Adagio Resurrection Dessert

   We prefer to serve fresh fruit but resurrect this recipe when our fruit is on its last leg: peaches, nectarines, pineapple, bananas, apples, etc., hence our name for Resurrection Dessert.

Grease casserole or 8x8 glass pan.

Pour in 2 cups peeled and sliced peaches or any fruit combination.

Sprinkle with cinnamon sugar. (All proper Dutch households store a shaker container of sugar mixed with quality cinnamon.)

Mix:

2 cups *yellow cake mix 
¼ cup melted butter
½ cup brown sugar
½ cup oatmeal
1 beaten egg
Water, enough to make thick batter.

Pour over peaches.

Bake 350° for 30 minutes or the cake topping becomes firm and golden brown.

"Eet Smakelijk"

Adagio Adult Family Home

Kim Edsall-Badgett

Maxine Brink

*We buy commercial-sized yellow cake mix so here is where your originality can shine.

TRANSITION

Grace transitioned this morning at 9:25. Her struggle with dementia is finished.

She taught me much. I now know patience is a decision made when I would prefer to walk away. I learned to release my grip on my agenda and listen to her expressed needs, garbled and vehement, but as legitimate as my own.

The person who thrived before dementia’s inroads took away her conversation skills still existed. She taught me to see the dead leaves and clutter beneath flower pots as offensive. Yet the pictures in her scrapbook are of lush dahlias and geraniums. She was a precise accountant and that mind set was evident as she made her bed and folded her napkin.

Before Grace, I did not know that death’s timing is off the clock. That it can nibble at your mind until it finally eats down into the brain stem, incautiously digesting the cells that on their own supply life to kidneys and lungs. Even in her loss she was gracious and easily smooched, “I like you.”

I did not know the danger in a nurse’s watch as it recorded seconds during which neither I nor Grace would ever breathe again.

Grace’s transition is complete. Mine without her has just begun. I miss you, dear one.

PEOPLE: TREENA

Treena reads a National Bestseller paper back under the hair dryer. Her small frame demonstrates her life-long disciplined eating habits and she wears tapered blue jeans with an ironed crease.  Her knit tee shirt bears no logo or witty saying, like "the trouble with reality is that there is no background music." She carries her wit in her head and speaks clearly with a wry sense of humor.

Her hair began thinning in her thirties, unlike her younger sister who inherited their mother’s thick hair. Three years ago her sister was diagnosed with Alzheimer's disease which she inherited from their grandmother. The inequities cause Treena to laugh and inform her expectations of beauty.

The People magazine cover next to her chair pictures only attractive people 50 years her junior and she mostly doesn’t care. Her life has been full and she now feasts on the overflow.

Treena gestures to her hair. “It stinks. But I have arthritis in my hands and arms and can’t comb the back. When my friends come to pick me up they comb the back.”

She volunteers the subject of wigs. “Last time I wore my wig to work, when I took it off I realized I’d worn it backwards all day.”

Alzheimer’s Association NAPA

If you’ve watched women’s college basketball, you will be dismayed by the news that the University of Tennessee’s legendary coach, Pat Summitt, confirmed she has been diagnosed with early onset dementia, Alzheimer’s type. She later told news media that her grandmother had suffered the disease.

On January 4, 2011, President Obama signed into law the National Alzheimer’s Project Act (NAPA). This legislative action passed unanimously by both Houses of Congress. NAPA establishes an Advisory Council on Alzheimer’s research, care and services.

The new Advisory Council will develop a national strategic plan to respond to the Alzheimer’s crisis and coordinate Alzheimer’s disease efforts across the federal government. NAPA will ensure the coordination and evaluation of all national efforts in Alzheimer’s research, clinical care, institutional, and home and community-based programs.

One of the most important components of NAPA is that it allows participation in the evaluation and strategic planning process by specialists outside of the federal government including patient advocates, health care providers, state health departments, Alzheimer’s researchers and health associations.

Why NAPA and Why Now?

The Alzheimer’s Association was the leading voice in urging Congress and the White House to pass the National Alzheimer’s Project Act. With a disease that is already impacting so many Americans, the Association recognized the need for a national, coordinated effort that pools the skills of all those working on the problem. The Alzheimer’s Association states the need clearly in its literature:

For too many individuals with Alzheimer’s and their families, the system has failed them, and today we are unnecessarily losing the battle against this devastating disease.

Alzheimer’s is the 6^th leading cause of death in the United States and is the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression.

Making her announcement, Coach Summitt said she had the company of her son, Tyler, during her time at the Mayo Clinic. He explained his mother's feelings after being diagnosed.

"Nobody accepts this," Tyler said. "And there was anger. 'Why me?' was a question she asked more than once. But then, once she came to terms with it, she treated it like every other challenge she ever had, and is going to do everything she possibly can to keep her mind right and stay the coach."

To read more go to http://www.alz.org/index.asp

ANXIETY 5

Ready or not, the political season is once again attacking us. Political candidates, pundits and pollsters attempt to define the anxiety of our country in economical and emotional terms. Anyone who does not agree with them in congress or the presidency is disparaged as partisan. This revelation should not knock your socks off.

Dissent and lack of control increase the level of anxiety and volume of proclaimed disbelief that anyone would hold to such an idiotic position. Comparisons to Hitler proliferate. I'm already weary of patriotism claims and accusations of terrorism.

The more anxious we become the more we slant the issue, stack the facts, and shade our witness in our attempt to show our position in the best light. The story can never reflect the whole truth because, with our hysteria controlling our reactive thought processes, we can’t see the whole truth. Our emotions warp our perceptions so our thinking spirals out of proportion. And as our thinking goes, so does our story. (More on this with future posts on Storytelling.)

We frantically defend our point of view as we vehemently dismiss our opponents. Anxiety blinds us to our part in the devilment, as it binds us in our need to convince others to protest with us.

In a troubled marriage there is no totally good spouse and totally bad spouse. In an angry family, there is no good parent and bad parent, as there is no single bad child and the rest escape as acceptable. In an organization a wide swath of grey wanders between the black and white. But we do so love to assign blame.

We are naturally wired to become anxious when threatened or we think we see threat. (“Anxieties of life” Luke 21:34) Loss of job, income, home, health, family. You can name your anxiety of the day.

As dementia diminishes the thought process, the sufferer thinks they can continue to take charge; sometimes they do, sometimes they don’t, and we never know what’s coming next.

A small coalition of members decide the leadership isn’t performing and they foment for change. The neighborhood around the church changes complexion as members move out and cash flow, with the membership, fails to meet agreed upon goals. Misbehavior alleged or real by a leader or member jump-starts the rumor mill.

Dr. Peter Steinke in How your Church Family Works, writes, “Crowd delirium is fed by both emotional extremes—ecstasy and anxiety. Both numb the thinking processes. As long as people function in reciprocally reactive ways, there is little emotional separation between them.”  Blobs wobble; differentiated individuals reason.

Like any challenge, anxiety's impact depends on how we handle it.