Abreaction: A Path Through Grief

Abreaction is the bringing to the surface of unpleasant suppressed thoughts and feelings in such a way that their being felt, emotionally, out in the open, lessens their power or hold over a person, and sometimes can seem to extinguish them completely. Abreaction is like a reverse lightning-rod, for it can “ground” tempestuous psychic energies that exist inside a person, in order that such energies will lose their power on the outside.

A vivid example of abreaction occurs in the dramatic conclusion of Alfred Hitchcock’s 1964 psychological thriller Marnie.

I found Mockingbird though my news feed link to this article “Grief, Gethsemane Hospital: Our Interview with Ray Barfield“. (I will take a longer look at the interview with Ray Barfield in another post. There is much to deconstruct and understand.)

As I tooled around the site which identifies itself as…”a ministry that seeks to connect the Christian faith with the realities of everyday life in fresh and down-to-earth ways”. Not dissuaded I continued to poke around with great curiosity what secrets Mockingbird may hold for me. Or at least point to a topic. I was not disappointed. They have a glossary of words. Abreaction was there. They have rich trove of articles.

A ‘reverse lighting-rod’ is a great descriptor for my thoughts on loss, mourning, and grief. The exercise of examining the grief we experience when a loved one dies is far more effective than denial as a way to manage grief. Experiences integrated into our current compendium of understanding creates new knowledge and insights.

Inside Out: A Compendium of Loss and Grief captures all the relevant posts on this topic. In death there is wisdom and knowledge.

The Venn of Two Deaths

We all share the same four chemical bases in our DNA thymine, adenine, guanine, and cytosine. They are assembled differently in each of us to create a unique human. Yet as unique as our DNA makes us we overlap with one another as a Venn diagram in varying degrees. Donna my wife died August 2011. A neighbor and friend M died this week. Where Donna and M differ and where they overlap in their diagnosis’s and death is telling about death and dying in America.

Diagnosis

Donna was diagnosed January of 2009. She had an X-Ray that showed some lesions and subsequent PET that confirmed Stage IV cancer. Donna was told she had Stage IV via voice mail at her office by her primary care physician.

In 2015 M discovered a small lump in her right breast while in England. A lumpectomy was performed and nodes were harvested. There was no distant cancers discovered in the nodes. A biopsy on the tumor show triple negative. Upon returning to the US radiation was performed and she was told she was cancer free. Four months ago M was having breathing issues with shortness of breath upon exertion. After a month of adjusting her Afib medications her cardiologist recommended she go to the emergency department of a local academic hospital. She remained in the ED for 36 hours during which she received an X-Ray of the chest determine if there was a pulmonary embolism. A PA came to her bed in the busy ED and told her you don’t have an embolism but there are lesions on your bone which is  cancer. M was discharged.

Donna was much younger that M by about 16 years. Donna had no underlying medical conditions. M had Afib.

Post Diagnosis Care and Treatment

Donna had a primary care physician (PCP) for over 20 years. Dr. S was my PCP as well for about 25 years. Even though Dr. S was a bit ham fisted with the voice mail about her cancer, he got Donna in to see the head of oncology at the academic hospital he has privileges at. The oncologist Dr. B. was simply said, amazing. He was caring, smart, focused on Donna, and became her team leader. During Donna’s first visit with Dr. B. he made it very clear to Donna. “I am your primary care physician from now on. Any physician or healthcare professional you see they check with me about any care they are giving you so I can manage it with them.’ From that point on all care and treatment up to and including hospice was lead by Dr. B.

Donna had a craniotomy for small tumor and Dr. B recommended a highly skilled neurosurgeon who we liked greatly and did an amazing job. Following the craniotomy Donna had whole brain radiation. There were issues with the radiologist. He was data driven and not entirely honest regarding hair loss. Of all the team members Donna had he was the least skilled at delivering complete care for her and communicating well. I believe this was age related since he was very young. His clinical care was excellent but there is more to radiology then math.

For the next two and a half years Donna had three rounds of chemotherapy. The first round stopped progression and shrunk two of the tumors. The chemotherapy that first round cause some nausea but not much else. Nearly 10 months later the tumors were growing and a second chemotherapy was started with less side effects. And the tumors again shrunk. In all her treatment was manageable and responsive. Dr. B gave us his cell number and we could text him any time or call. He was very responsive via email as well.

M did not have a primary care physician. She had a cardiologist for an underlying issue. The cardiologist management of M ended with the cancer diagnosis. At this point the radiologist who treated M breast cancer a year and half earlier and who M respected recommended an oncologist within the hospital system. M’s daughter and I went with M to see the oncologist on the initial visit. This oncologist was not Dr. B. she was clinically skilled but the issues with communications and listening to M and her daughter were lacking. M made it clear she did not want any chemo since this was Stage IV. The oncologist already had in mind a treatment plan and presented it without consideration for M’s clearly stated goals. This oncologist also recommended a PET to determine and extent of the disease as well as a biopsy. Again the oncologist was focused on delivering what she thought was clinically best care and not what M wanted.

M had the PET. Refused an MRI to look for lesions in the brain. M also was reluctant to have the biopsy but did.

Following these tests M, her daughter, and I went to see the oncologist for her second visit. The oncologist offered an oral chemotherapeutic agent and a bisphosphonate injection. M got the injection and filled the Rx. A major quality of life issue for both M and her daughter was the shortness of breath and how M was having great difficulty walking more than a few feet. The oncologist told M that her lungs were clear and said she thought this was an issue of the cancer in some way or perhaps part of the cardiology issue. M and the daughter could not get a clear concise answer. They were both frustrated. M asked about prognosis. That was more difficult for the oncologist as it is for any physician. M and the daughter asked about the biopsy. It took 10 minutes and a two different sites for oncologist to say I don’t have the results from a week ago. Finally she found the pathology report and said it was not complete and had to be redone but it was highly likely the lesions were from the breast cancer and were diffused.

M and her daughter left frustrated and unsure of what was going on. M went home and began the oral chemo. The shortness of breath remained the major issue that remained unaddressed. Over the course of the next two weeks M was growing more tired and the breathlessness was debilitating. The daughter called the oncologist frequently regarding the breathlessness. One rather tense call that offered no help or resolution the oncologist said that M was not her only patient. Finally M went to the ED one early morning. The ED attending sent her for an MRI. A pleural effusion was identified.

It was at this point the relationship between M, her daughter, and the oncologist broke down. The oncologist was still recommending chemotherapy. M was still saying no way. When the PA noted that on the original PET that there was some fluid in pleural cavity. M’s daughter was livid that it was not noted earlier. The oncologist was defensive saying it was very little fluid. Words were exchanged.

M was admitted for a throacentesis. On the unit M came under the care of the hospitalist.  A pulmonologist was brought in to perform the throacentesis. The oncologist remained a participating team member and was still talking chemotherapy. Following the throcentesis breathing returned to normal. M said to me, “This is amazing I am feeling so much better like life is worth living.”

M and her daughter while in the hospital met with the social worker and began the process of applying for home hospice. M was discharged and went home. A local company providing home hospice support.

Hospice

Once home and the breathlessness largely resolved M rested and was doing well. Ten days to two weeks post discharge the breathlessness returned and in the middle of the night an ambulance was called to admit M to the hospital. The pleural effusion had returned. M was scheduled for a second throcentesis which would be done at an other facility. Placement of a drain was recommended in order to avoid continued pleural effusions. This time the wait for the throcentesis was ten hours.

M got back to the hospital late that evening completely exhausted. For the next week M’s daughter took on the task of finding a hospice or nursing home for M. During this period M was bedridden. She had stopped eating and was awake and talkative for short periods of time before falling asleep. I saw her each day with a kale spinach pineapple mint, and apple smoothie. She remained sharp and funny.  Her daughter was fighting to find a place for her mom and doing all the end-of-life paperwork. M was denied hospice because she was, as described by the hospitalist, “not actively dying”. M died a week after her second throcentesis in the hospital. Her daughter was with her and aggressively intervene to stop life saving measures being taken, M had in place a DNR.

Donna was in the hospital and had two throocentesis’s neither of which was successful. It was after the second on that Dr. B her oncologist called a meeting in Donna’s room to discuss palliative care and home hospice. As well as that meeting was orchestrated and run Donna shut down. I was contacted by the hospice group and set up home hospice. The effects of the whole brain radiation was beginning to present with Donna. Delirium was beginning as was Sundowning Syndrome. The palliative care team noted that her most recent MRI shown thinning for the cerebral cortex which is consistent with Alzheimer’s Disease.

By the time it came to bring Donna home, one week after her admissions for the throcentesis, Dr. S (our PCP), Dr. B., and the palliative care team recommended that Donna be admitted to the in patient hospice unit. They were not convinced that at home hospice was the best for Donna nor believe I could deliver the care she needed. On July 18, 2011 Donna entered the hospice where she remained until August 7 when she died. That is the median time for patient stays in hospice.

Donna deterioated over the weeks in hospice. First slowly and then more rapidly. Dr. S and Dr. B came to review her charts, not much to review, but mostly speak with me. There was absolutely no abandonment of Donna when she transferred to hospice from her primary care team. In addition to Dr’s. S & B there was the palliative care team, the social workers, clergy, and volunteers who were there for her and me. We were embraced at the the single more critical time in both our lives.

The Part of the Venn That Didn’t Overlap A Patient Advocate

M and Donna both died from cancer. The diseases were different but the clinical path for both were similar though the time frame was longer with Donna. The difference that stands out for me was the clinical team.

M did not have a primary care physician who had 20+ years of medical care. Donna did. M did not have an oncologist that was brought into to treat her by her primary care physician. M did not have the an oncology team on hand when she was home during her short treatment. Donna did. When M was hospitalized she had to rely on a hospitalist. Donna had an oncologist who had cared for her for two and a half years and a primary care physician who cared for her for 20+ years. Both were active when Donna was admitted.

Clinical care for M met the standards of care and was delivered skillfully. The weekly change of hospitalists was smooth because the charts were done daily. What M and her daughter did not have that Donna and I had was a team that advocated for Donna, communicated among themselves, and delivered the care that Donna wanted. There were the clinical advocates for Donna and me. M had a clinical team that advocated for standard of care. (That may be harsh and that is unintended on my part.)

The single most important thing you can do for your healthcare is to find a primary care physician and create a long term relationship. Over time the physician will understand the goals and desires you have for your healthcare. They will know your medical history as well as anyone can. They, hopefully, will become your advocate for you if you are seriously injured ill or facing difficult life decisions. The primary care physician is your single most important advocate.

Mail to Self News Feed #3

I found the Mail to Self app a year and a half ago. It is genius in its simplicity and productivity. At the same time maniacal in the burden of its output. Where I mail a ton of articles to read later, which pile up. Here is the recent few to share in my personal News Feed.

A letter to … the kind stranger who shared her grief with me

From The Guardian with a single clear message for all who grieve.

 “Try not to hide your grief,” you said. “If you talk about it, you will discover so many other women who have been through what you have been through and talking about it honours the sadness and helps everyone.”

I couldn’t agree more, honor the sadness and find a way to help others.

Grief Has Many Steps

This is a two part series published in Umpqua Post out of OR. Part 1Part 2

Part One discusses the stages of grief less from the Kubler Ross Five Stages and more from the idea grief is not on a schedule and it is unique to all of us.

“They state that normal grief usually only lasts six months or less. A prolonged grief reaction lasts longer than six months and includes intrusive thoughts related to the loss of the person, intense feeling of emotional pain, or yearning for the lost person.”

Part Two takes a look at who is at risk for having a difficult time with the loss of a loved one.

 “If a person was highly dependent on the relationship with the person who is gone, dealing with the loss will often be much harder. Those who have poor social support or history of abuse or neglect themselves will often have prolonged or abnormal grief reactions. And one of the most difficult losses to deal with is the loss of a child.”

The article ends with this, which fits with my writings, podcasts, and book.

“All sorrows can be borne if you put them in a story or tell a story about them,” said the writer Isak Dinesen.

Excellent

When Grief Looks Like ¯\_(ツ)_/¯

An interview with Rachel Ward a podcast producer with Gimlet. Her husband died unexpectedly at age 35. Rachel was 32.

Sudden death vs. a prolonged terminal diagnosis is different but the grief feels the same.

“Um. I actually feel moderately okay in my grief. Like I feel like I understand like some of the dynamics of like when in the year I’m going to feel a little less capable or more capable. Among people that I already know I feel pretty comfortable bringing him into a conversation and being like, “Ah, Steve used to say this really funny thing.” So in relation to my own grief like I think I’m going to give myself a 6 out of 10. The thing I worry about is being like stuck a little bit.”

A very comforting. Listen or read the transcript.

Transactive Memory Extending Our Own Memories

I’ve written about the the inherent reflective nature of my loss and grief and how memories of Donna and our life would come in fits and starts. These moments become fulcrums to move my life forward and advance my self knowledge, us (Donna & I), and living in this world. This simple idea of ‘I remember this‘ becomes more complex when examined from what is not remembered. We don’t know what we don’t know. Like wise you don’t remember what you don’t remember.

Donna did not dwell on her illness. She did openly fear her eminent death. She gave me her illness to manage. Any thoughts of death any fear of death were held tightly in her heart. Donna wanted to remain alive and to live as she always had, on her terms. The interruptions of doctor visits, treatments, side effects, and pain was when she stoped to recognize the disease. As quickly as that happened it disappeared into my hands. My area of expertise/skill was managing the day to day disease. Getting her, nah going with her, to all appointments. Making pill packs at home.

I’ve attributed this division of labor to Donna’s desire to be disease free, it was not about denial as much as it was about division of labor. As a couple, I suspect like most couples, we’ve always had a division of labor. I would do the cooking. Donna would buy the kitchen items, dishes, pots, pans, etc. since they had to fit with the design of our home her visual eye. I would be the one to change the sheets. Donna selected the sheets and cases.

Transactive Memory

It turns out that this is Transative Memory. Transactive Memory is the fact people in continuing relationships  (in organizations as well) become specialized in different functions of labor within the relationship. Part of that specialization is the ability or skill set where the various members of the relationship manages different knowledge domains. One parter may remember all the details of what is needed to manage specific a area, Donna knew what sheets, shams, duvets, etc that went with what for each season. While I would be the one to change the sheets in a heartbeat. This is Transactive Memory. We used each others memories as our own. I didn’t not need to know color or style. Donna didn’t need to know how to make clarified butter or a hospital corner.

Transactive Memory in romantic relations improves self-esteem, life satisfaction, and happiness. Add to these benefits emotional support, companionship, and security. (Donna and I felt so very secure around each other and with each other.) It is postulated that romantic partners pool cognitive resources to increase our collective memories/information with less work. This pool of cognitive resources created a rich network of memories for us and after her death for me.

“Additionally, because people know about each other’s expertise (and non-expertise) they can make judgments about the reliability and value of any information conveyed. It is easy to see how a shared transactive memory system might work to help couples navigate their daily lives with ease and efficiency.”

The interesting part about Transactive Memory is that the theory and research shows that it is about the transaction or communications between members or a couple to encode, store, and retrieve information. Donna could give me a look and I knew what needed to be done. Or I could look perplexed and she would jump in. At the center of this theory is cognitive interdependence where the individuals depend on the knowledge of others and the outcomes are dependent on their knowledge. I learned to cook as a child. Donna was not a cook. So cooking became my knowledge area.

“…recruited couples who had been together for at least 3 months, and found that they used each other as extensions of their own memories, outperforming pairs of strangers at remembering category exemplars in different areas of expertise (for example science, food, spelling).”

Remembering What You Don’t Remember

Those memories (skills) Donna had died with her. Though they were effectively removed from my heart they were not lost as much as witnesses to deficits in my life now. Twice a year when I am faced with changing the shames and duvet I remember what I didn’t remember, Donna did this. This loss is not the same as loss and grief of Donna but the reality that we played well together and made each other better. I grieve for that balance between us where we as Donna and Mark would create new and better and do faster and more effectively.

When you remember what you don’t remember the hurt is as real.

Mail to Self News Feed #3

I found the Mail to Self app a year and a half ago. It is genius in its simplicity and productivity. At the same time maniacal in the burden of its output.

The app is added to your phone. You enter an email address into the app. After that when you swipe up or go to share a web page, article, etc. there is a button for Mail to Self. Just tap it and whoosh you got the article URL etc. in your inbox. The workflow is this. I will keep looking at my news feed, my papers, my sites, etc. and just mail to self to read later. Not so fast. My inbox is filled and I am not reading later cuz I got the attention span of a gnat

To repair the gnat in me I am going to post twice a week some of the articles I mailed to self. This is a way to share them with my non/imaginary readers and to force me to achieve inbox zero.

Spiritually Speaking: Grief sticks around after the flowers wilt

Beryl Schewe writing in the Eden Prairie News offers a unique way to address a loved ones grief when words fail us.

If only grief were so easy. Long after your flower arrangement has composted, grief lingers on. Grief has a way of showing up like an uninvited houseguest who refuses to leave.

Schewes’ idea is to send a book. She offers a selection of five books one of which includes C.S. Lewis’ “A Grief Observed” which is my favorite read that I have returned to frequently. Hop over and take a look.

TED Talks: What Makes Life Worth Living in the Face of Death

Lucy Kalanithi

This is a stunning and powerful TED talk by Lucy Kalanithi a physician whose husband was diagnosed with Stage IV Lung Cancer and died 22 months later.

Much of what she says and addresses are very close if not similar to what I felt and what Donna did with her life after her diagnosis till her death. Donna and her husband Paul may not be identical but the one point Lucy made that rings true for both Donna and I is this:

“Our job isn’t to fight fate, but to help each other through. Not as soldiers but as shepherds.”

I was the caregiver and her shepherd. She became my muse and a shadow for the remainder of my life.

There’s a poem by W.S. Merwin — it’s just two sentences long — that captures how I feel now. “Your absence has gone through me like thread through a needle. Everything I do is stitched with its color.”
Oh so true.

Mail to Self News Feed #2

I found the Mail to Self app a year and a half ago. It is genius in its simplicity and productivity. At the same time maniacal in the burden of its output. It is a ersatz news feed for me.

The app is added to your phone. You enter an email address into the app. After that when you swipe up or go to share a web page, article, etc. there is a button for Mail to Self. Just tap it and whoosh you got the article URL etc. in your inbox. The workflow is this. I will keep looking at my news feed, my papers, my sites, etc. and just mail to self to read later. Not so fast. My inbox is filled and I am not reading later cuz I got the attention span of a gnat

To repair the gnat in me I am going to post twice a week some of the articles I mailed to self. This is a way to share them with my non/imaginary readers and to force me to achieve inbox zero.

How to have a better death

This is from the April 29, 2017 Economist and perhaps one of the best articulated and presented cases for end-of-life care.

Most important, these medicalised deaths do not seem to be what people want. Polls, including one carried out in four large countries by the Kaiser Family Foundation, an American think-tank, and The Economist, find that most people in good health hope that, when the time comes, they will die at home. And few, when asked about their hopes for their final days, say that their priority is to live as long as possible. Rather, they want to die free from pain, at peace, and surrounded by loved ones for whom they are not a burden.

This is counter to what I’ve read and seen. Many patients receive hospitalized treatment that saps quality of life and renders the final days unbearable. All of this because family and friends want medicine to do everything possible to extend life where extending life is destroying life. And this is without consideration of what the loved one wants.

The Economist notes that death in the hospital means greater pain, stress, and depression for loved ones. While compared to similar patients in hospice. Death in the hospital leads to family strife and prolonged grief.

Donna was placed in hospice. She died in hospice. Her care there was loving and kind. My care from the hospice staff and her oncologist was supportive and focused on my long-term outcome. As I’ve said ‘Hospice saved my life.’

There is much to consider and learn in this short editorial. It ends with this:

But honest and open conversations with the dying should be as much a part of modern medicine as prescribing drugs or fixing broken bones. A better death means a better life, right until the end.

True that. True that.

A Guide to the Best Sipping Rums Under $50

Rum is a new stop in the sophistication of my liquor taste buds. Typical of the times and what was trending there was beer and vodka. Of course wine but truth be told I know when I have a good wine but since they are mostly French, Italian, or Spanish remembering the names escaped me.

A few years back Ward III joined our block. The bar is one of the finest cocktail bars in NYC and the owners are amazing people who over time became friends. As with friends you share and discover what they like. One of the bartenders at Ward III introduced me to Rum. Not Rum and coke but, sipping Rum served neat. Just like Rye whisky or Bourbon. I saw this review and thought I would share it with you all.

Yo, Ho, Ho, and a Bottle of Rum

Some Grief Lasts a Lifetime

From the SF Bay Times

You’ll probably always feel sad when you think of Tim. And, really, would you want it any other way? Your grief is also your link to the love that you feel for him. I think a better approach than trying to “get over” these feelings would be to respect their essential dignity. Treat your grief with respect, not as a weakness from which you should “recover.”

This fits with my view, Closure is indifference. It is denial said pretty. Here are my thoughts on this topic.

This is from The Guardian and again points to the understanding that grief is not loss but opening yourself to life.
And yet, says Julia, running away from it means we will never recover from it. Embracing it, moving through its agony, and allowing ourselves to just be while it washes over us, is the only way to survive it; because we have to feel the worst of it in order to let it change us, and then we can start to find out who we are going to be in the wake of it.

Mail to Self News Feed #1

I found the Mail to Self app a year and a half ago. It is genius in its simplicity and productivity. At the same time maniacal in the burden of its output. It is my mini me news feed.

The app is added to your phone. You enter an email address into the app. After that when you swipe up or go to share a web page, article, etc. there is a button for Mail to Self. Just tap it and whoosh you got the article URL etc. in your inbox. The workflow is this. I will keep looking at my news feed, my papers, my sites, etc. and just mail to self to read later. Not so fast. My inbox is filled and I am not reading later cuz I got the attention span of a gnat

To repair the gnat in me I am going to post twice a week some of the articles I mailed to self. This is a way to share them with my non/imaginary readers and to force me to achieve inbox zero.

Parting Shot

Angela Chen writing for the The Paris Review examines the ‘the words that bookend a life.’ Specifically she examines the West’s concept of famous last words and East where premeditated death poems (jisei) are a long tradition.

Chen points that from the start the last words of Jesus on the cross opened the entire exercise where during the Enlightenment one and all were excepted to offer up brilliance and insight minutes prior to dying.

This was in direct counter point to the Japanese. Elderly samurai and those in the upper class were spurred to compose death poem that would be shared for criticism and input. If you ask about the fear of sudden death in the Japan.

“…Narushima Chuhachiro, who started drafting death poems at fifty lest he die unprepared. Chuhachiro sent this one to his poetry teacher: “For eighty years and more, by the grace of my sovereign / and my parents, I have lived / with a tranquil heart / between the flowers and the moon.” The teacher’s response: “When you reach age ninety, correct the first line.”

Donna was in hospice for her last 18 days. I would be there daily and at night. One of the attending on the staff said that to be present at the time of death is rare. I wanted to be there less for this last words but so she would not be alone. I was home walking the dog and got a call to hurry back. The cab driver went the wrong way and I was not there for her last words or otherwise. Here is a podcast about Hospice and Beyond.

As I read Chen’s article and consider last words vs. death poems I lean toward the poem. I see my blog as my death poems albeit long form. Though I would think of it in terms of a meandering suicide note.

Parting Shots is a short article but one we may all want to consider. Either rehearse our closing act or start thinking about how we want to be remembered. I am guessing that what is left on the Internet is what will be remembered. So save wisely.

How to Find Meaning in the Face of Death

Emily Esfahani Smith writing in the The Atlantic from her book The Power of Meaning reviews the work of psychiatrist William Breitbart chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering. The question on top of mind when given a diagnosis of terminal illness is less about when I will die or how much pain, it is about what makes life meaningful? “Meaning that cannot be destroyed by death.”

Esfahani Smith presents recent data addressing that meaningful lives are demonstrated because of three factors, my existence is valued by others, I am driven by a sense of purpose or important life goals, and I see my path to this point as coherent and integrated. Though as I review my writings there is a struggle to find meaning and purpose.

“Psychologists and philosophers say that the path to meaning lies in connecting and contributing to something that is bigger than the self, like family, country, or God.”

Breitbart wanted to help patients build meaning and reduce suicidal ideation. His work was to create and eight session group therapy program of six to eight cancer patients. Each session was structured around set questions that the group were asked. In the first session participants were asked about moments or experiences that were meaningful. In the second session patients responded to who am I. In the final session they were asked to what part of them would going on living after death.

Breitbart went on to perform three randomized, controlled experiments on meaning centered psychotherapy. His results found this work was transformative, patients attitudes toward life and death changed with less hopelessness and anxious about death. Spiritual wellbeing improved.

Breitbart comments that the time between diagnosis and death is an opportunity for “extraordinary growth”.

Two observations from my world. After Donna died the entire world I lived in lost most of its meaning and purpose. Most of that loss is directly related to Donna but a lot of is to do with my failure to find work or find what I wanted. I live with the sense this is the end I have had all the meaning and purpose in my life. My friend Scott writes about this top at Age Spots Blog so hop over and take a look. Right now I vacillate between oh fuck to there is something here to find and uncover.

My second thought is that Breitbart is right, there is extraordinary growth between dx and death particularly when you are a caregiver for someone dying. And that growth extends well beyond the death though the experience of grief and the role it plays in knowledge acquisition and understanding of ones emotions and life.

A bonus link in the article is here, it is a “Meaning in Life as Comprehension, Purpose, and Mattering: Toward Integration and New Research Questions” A long details examination of this question by psychologists. Enjoy

Judging my grief? Move on…

This article is well outside my usual link and opinion. This was from a The Tribune India which is one I do not normally or ever read. Second the opinion here is 180 degrees opposite of my thoughts on closure.

Closure is indifference. It is denial said pretty. I subscribe that grief and loss can be a window into our loved ones, ourselves, and the world at large. This is from a Poem Unconditional by Jennifer Welwood and captures my thoughts on closure.

Unconditional
Willing to experience aloneness,
I discover connection everywhere;
Turning to face my fear,
I meet the warrior who lives within;
Opening to my loss,
I gain the embrace of the universe;
Surrendering into emptiness,

I find fullness without end.

Get Vaid writing in the The Tribune captures a societal view of grief that I had not considered.

“Oh, she is fine. She is moving on in life already,” the thinly veiled ‘judgment’ pierced through my ears as I heard someone at work talk about a friend’s widow handling her recent bereavement.”

We all grieve differently. Those of us who grieve know full well the reality of our grief and the importance to not judge others grief. Vaid is addressing the inverse of what I have witnessed the well meaning friends or family members who say it is time to move on. Date someone as if dating is a cure for loss. This article and discussion is about how people set standards for grief and expect you to live up to it, their standards.

The bigger issue here is that we must allow those to are grieving to do so at their pace and way. Only if the grieving becomes pathological and complicated then should we help them find support.

“Moving on is not a stigma or blasphemy, life moves on.”

Self-Compasion, Mindful Meditation, and AA

Take the random nature of the universe, add Amtrak, and read an amazing CV, bingo I am now taking an eight week course in self-compassion and mindful meditation.

Back to the start. I was on an Amtrak train retuning from PAX Boston and got a seat across from a young woman. It was the quite car but we chatted on and off for a couple of hours. I am the old black humored widowed guy so any attention I get from a woman is surprising. Part of our chatting was about course she was teaching which she noted may help with the grief. We did what all the cool kids do, we friended on FB.

Switching to my stalking mood I looked up her profile and the course she was teaching. In my mind there was this connection, no not to her, to the course and where I stand, sit, rest, and hate about my life. I said to myself, ‘Self this may be a chance to look deeper at your life and your goals.’ I signed up for the course. Today I am six classes in.

This video lecture by Dr. Kristin Neff is the essence of the course. There is much there to untangle and consider. Overall it speaks to ideas that may help us as we navigate life. Of course there are quite a few questions about this that I am still sorting out and how I will integrate it into my world. Overall, as with anything worth doing, there is a positive attitude one should have before casting it aside. More on that after the  course is completed. Right now this course is a friend with yet to be determined benefits.

AA vs. Self-Compassion

The Big Book
The day to day guide to sobriety

This course takes place at an austere Tibet Center. So the mood is perfect. The course is taught with a mixture of lectures (reading stuff at you), meditations, homework, and discussions.

The discussions are generally done in the “Tell us what you feel about xyz?” Which opens the floor up to the following:

‘I find that I am able to clear my mind and think about flowers.’

‘I hurt my ankle and when I meditation it seems better.’

‘I have more compassion for others who I normally wouldn’t.’

All and all these are benign statements in the universe like so much detritus, yet important to the speaker, so credit given. I found myself wondering if this was the depth that would benefit me upon reflection to learn and grown? And then my mind went to past friends from who were in AA and shared their feelings.

‘I got so blackout drunk that I woke up in the backseat of car in Atlantic City with one shoe missing.’

‘One Thanksgiving I tried to beat my dad with a turkey drumstick.’

‘My family abandoned me after I took all their savings and spent it on booze.’

Those AA shares are raw emotional statements that tell a life story from those fighting to return from the brink of profound loss and suffering. Both sets give the listener a place holder to examine life their own lives because that is what sharing does create reflection points. The later set is raw and opens wounds. The prior are statements are observational and ricochets off of the depth of self. The listener needs to dig harder in one to find meaning while the AA stories are cringe worthy they encourage reflection, deep reflection.

Then last week this sharing story exercise reveled an AA type moment where I may need to consider my harsh analysis of the sharing in this course.

A woman in answer to the lecturers question on compassion for others shared this:

‘I was with my eight year old daughter for the day and we went to YMCA to use the pool. She was being and eight year old and it was frustrating me to no end before, during, and after being in the pool. As I was drying off I notices a disabled child with her dad in the pool and thought about the love of a parent for a child and what we do. When the child and dad exited the pool I saw that the disabled child was leading the blind father to the locker room. I realized the compassion I have for myself, my daughter, and others.’

Optimism or Pessimism

This raises to the level of AA and opens up the entire compassion moment and a depth of insight. I am reminded of a joke about how to identify and optimist.

Two boys age eight are selected to determine who is the optimist. One at a time they are placed in room knee deep with horse poop. The first boy freaks out and is cowering in the corner crying. He is taken out. The second boy is put in the room and he immediately begins to dig and dig in the poop. When asked why he says, ‘With all this horse poop there must be a pony in here.”

I guess I am looking for that pony.

The Tyranny of a Blank Piece of Paper

The tyranny of a blank piece of paper is know by anyone who writes or needs to get a proposal done. It is not very different from the death of a spouse, each day begins with a blank page.

I will repeat my mantra about closure because during a class I am attending a fellow student reacted in horror when I said ‘Closure is indifference, it is denial said pretty’. I guess not seeking closure following the death of a loved on is abhorrent to some. You can find my various posts on closure here, here, here, and here and why it is not a bad thing.

It has been six years since Donna died. I can say I am largely out of woods of grief though there is a new grief. The grief of how am I going to find my way forward when the fabric of my meaning and my purpose is in tatters. The path forward feels as treacherous and riddled with obstacles as anything that grief over Donna’s death has presented.

Filling The Silences of Time

During these blank page days I find myself filling silences of time with unimportant activities. Those small meaningless tasks flash a moment of purpose and just as quickly are replaced by ‘this is what life has devolved into: stacking books in size order, cleaning the glass coffee table (again), empty the dishwasher (that is never filled), do a load of laundry, etc’. Let me not gild the lily here, I do volunteer at an animal shelter and other organizations. I have written a book and am pitching it so all is not desperate. I am taking classes.

Time becomes the interstitial spaces between activities. Compare what I am doing today to what I did prior to Donna’s diagnosis or during her caregiving. The value my time has for me and how I feel about that time is profoundly different today than it was then. The time I have on hand now is greater and echoes in the silence of my own breathing.  Previously the spaces of time between ’things’ was compressed. It had its own heart beat and rhythm. I was able to do all that I wanted to do and needed to do plus run a business or care for Donna or consult. The busier the person the more they can do seems to fit here. I am a slow-mo version of who and what I was.

Another and more apprehensive comparator of then and now is enthusiasm. Not sure I can quantify enthusiasm then to now. Then, the activities were keeping the business open and going. Pay rent. Paying salaries. Pitching business. Those tasks may not qualify as enthusiastic endeavors. They had to get done or else. They were part of a larger life and movement though time.

Comparing Then to Now

Today am I enthusiastic about emptying a dishwasher? It doesn’t have to get done. The dishwasher got done before because it was in the way of the next thing to do, watch TV with Donna or make dinner or go to a movie. Meet with Donna’s oncologist. Now the dishwasher gets emptied because it is an activity that fills space and time. The word enthusiastic may overstate what I am saying but, it felt like there was drive to do and do more then and in doing those things feel accomplished and enthused. Now, not so much.

I have been noticing that I am looking for things that I can loose myself in and relish the time spent lost. In this day and age of WWW and social media there is an abundance of things to do, watch, read, and follow. Those all become a passing moment, literally a glancing blow to my attention. Why?

My curiosity is as active as it has ever been. I want to devour as much as I can especially new things. Though the  bouncing from activity to site to podcast to book is the blinking neon sign of ADHD. I feel as if i am trying to find something to lock onto. I was locked into caregiving or my business. Now?

Case in point, I am a fan of the video game Destiny. I’m new to gaming. You can read about me and gaming here, here, and here. Truth be told I am not playing many if any other games which right there is a bit of this dragon fly behavior, darting around a pond touching the waters surface for a second and moving on. A new Destiny, Destiny2, will drop in September. I have been listening to Bungie Podcast and following players. My excitement extends beyond the game to thinking about what is like to create something to launch it to test it. My comparison point is working in pharmaceuticals knowing what it takes to get a drug to market and how similar this feels. All the phases of testing the product, identifying messages based on the outcomes, marketing, and launch. I wrap the warm blanket of my past around this new world and have a burst of enthusiasm. Dare I say focus. And …

And

I had lunch with my lawyer who is retiring this year. We were at a lovely little Vietnamese hole in the wall called Pho King. (Howard has been to Vietnam many times and remarked how good the food was. As good as the street carts in Hanoi he said.) I was bitching that I need to buy a new oven. He said without thinking, “That should take up three weeks of your time.” And there you go. Filling time with activities. In a way it is the theory of brief cases. Have a big brief case you fill it up. Have a small one not so much. That is time these days a big brief case that you need to fill sans enthusiasm, meaning, and purpose.

I remain undaunted to find that one or two activities that motivate me that fill me with ongoing wonder and hope where I can loose myself in. The poem below seems to capture that, discovering a place for the first time. I look for the return to the place I started for the first time.

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
                        Little Gidding V,
                        Four Quartets.
                        — T.S. Eliot (1943)

Sundays and Banana Bread

It was Sunday and I was getting ready to make some banana bread.

She called out from the bedroom, “I am going down to Century 21 to pickup some things.”

I rolled my eyes and took a deep breath to steady my response, “Okay but don’t spend a lot.”

Now in the kitchen looking at me with that smile of WTF, “I work, my money, I pay half the bills, and savings so shut up. Besides there is always a sale, so it is free.”

Pulling at my logic, “Its not free, even on sale, you pay something.”

Turning to head out she notes, “It is free especially if I buy two for the price of one. One is free.”

I can’t win, “Okay I am going to start the banana bread. You can have some when you come home. Bye.”

“Bye bye, la la la la” she sang as the door closed behind her.

 Sunday Dinners

It’s Sunday. My bike ride is done, her lattes were made and finished, the Sunday Times devoured, played with the dog, and now looking at Sunday recipes at rest on the stainless steel island.

I run my fingers over the listed ingredients to animate them. Make these black letters and words on white paper come to life. These words expressed in this order will fill the kitchen with the scent of warm embracing flavors and create a home, the home, our home, for us.

As a child Sunday meals anchored the family. That and going to church. We’d pile into the Ford dressed in our church outfits for the 10am service. My brother and I wearing ties, jackets, and feeling constrained. Dad in a suit. Mom in a dress and my sister wearing a print frock and hat. I was an acolyte for my teen years. An acolyte needed to be at St. Andrews early to put on the cassock, cotta, and light the candles.

The service ended at 11:30. And then we’d pile back into the Ford loosening our ties and the top button on the starchy white shirts poking and prodding each other with all the pent up energy of children held captive. We’d race into our rooms strip off the church clothes being yelled to to hang everything up.

Mom would do most of the work preparing the Sunday meals. We would be charged with setting the table, the dinning room table, not the kitchen table. Forks on the left. Napkins under the fork. Knife and spoon on the right. Water glasses and plates. There was always a table cloth. It felt elegant, stately, and formal as if we were dinning out within our own home. Afternoon sunlight came though the dining room window and the place settings cast shadows on the white table cloth in a still-life moment.

While dinner was being cooking the Sunday paper was consumed which included the comics in the Star Ledger for the kids. Mom and dad would fight over the Sunday Times Crossword puzzle.

The food was only part of this day. It was the act, the real life moment, of sitting and eating that made it Sunday. “Please pass the carrots. May I have some more chicken? Can we watch Disney tonight? May I be excused?” And then there was the instructional moments, “The fork in the left hand!” “Use your knife with your fork. “Sit up don’t slouch over the plate.” “Put your napkin on your lap. Chew with your mouth closed.” We were all there all present all engaged around a meal with each other.

During the teen years there was the sullen jealous arguing of siblings. The sharp retorts to imagined insults or hurts that fractured the meal which at times ended with “Leave the table and go to your room, now!”

The specifics of the meals were there but the memory has a larger life. It is the family gathered around the a table like an alter offering the warmth and comfort of a meal in a split level suburban home. Eight steps up to the living room, dinning room, kitchen, three bedrooms, and bath. Eight steps down to the rec room, spare room, utility room, door to patio and yard, the utility room, and garage. Sitting in a small subdivision in central New Jersey. NJ was a long way from the tenement in a Worcester neighborhood where the entire side of my mothers family lived. Sunday meals there were events of a magnitude that rivals King Arthurs Court. Extended family members grandmom’s, aunts, uncles, etc. sitting around the table talking and arguing about everything and anything. Politics, something called the stock market, work, and the crazy uncle who was not there. Mom, grand-mom, and aunts all jammed into an apartment kitchen cooking without a bump or foul. A ballet of food and fire.

This was as close as I got during those early years to imagine what it must have been like living in a village a hundred years earlier where everyone was family. This tenement in Worcester translated well to the split level in NJ. The warmth of the kitchen the food aroma, the chattering over dinner and the sense of family. Family is less about a birth order and more about environment. Sunday dinner was the environment that reinforced family.

She didn’t really have that family Sunday dinner environment. Loss of her dad when she was young. An older brother with issues. A mother who worked to keep a roof over the family. I think more importantly was the fact her mom was not a cook.

I wanted to return to those Sunday meals for me. It was less an active choice and more instinct or DNA. Since it was only her and me. Our Sunday meals did not begin as plan to make up for what wasn’t. It happened over time. Beginning in small cramped apartments and kitchens making something, eating together, sharing a bottle of wine, and steeling ourselves for the week to come. By the time we ended up here 28 years ago the Sunday meal was an event. She would set the table. On the Sundays she cooked I set the table and washed the pans etc.

Sunday Dinner Dishes
Franciscar Dishes

She would select the dishes as carefully as she set type. Were the settings to be the midcentury Jetson looking dishes, her mothers traditional set, the Martha Stewart set in taupe, or the Fiestaware. Dishes were chosen according to the meal and the season or the date. Placemats matched and the silverware pulled along with water glasses and wine glasses. And of course linen napkins. It was Sunday, no paper napkins.

This preparing the table was independent of my youth yet resembled it so well. There is that part of us deep within the brain that seeks order, family, comfort, peace, etc. It was less about trying to give back what she lost as child but more that we as humans crave that prehistoric life around the campfire. In my mind I began to rationalize Sunday meals as returning to her what was lost.

 Baking Banana Bread

Right now the table was waiting till she was back from Century 21. Make the banana bread.

I went to the pantry and pulled down the container of flour. Removed the cover and reached in for the scoop. Slowly sank the plastic scoop into the flour and watched small mist of flour plum up. I poured it into a one cup measuring cup. A knife was scraped over the top to ensure its level with the rim and emptied it into a bowl. I repeated it again and returned the flour to the pantry and took out the whole wheat flour. Measured 1/2 cup repeated the actions. Added 2 teaspoons of baking soda and 1 teaspoon of salt.

Two cups of sugar and two sticks of butter were placed in the bowl of mixer and turned to low. Slow steady turning of the paddle attachment pulling and pushing the butter and sugar together. The color and texture changed from white and yellow to golden softness shinning ice like.

Now for the fun part, mashing six bananas. The bananas were lying in the bowl. Small logs speckled brown and soft. I picked up the potato masher with the red plastic handle given to me by my mom when I got my first apartment after college. It and the other utensils were from the 1950’s. They were classic and weighty. I slowly pushed down on the bananas and watched the fruit squish and rise up between the ends of the masher. The repeated mashing produced a grey colored wet paste. Resembling mud at the edge of pond.

To the mashed bananas four eggs were added and whisked. The gold of the yolks blend into he mashed grey bananas. The yellow swirled in a vortex and slowly disappeared into the bananas changing the grey to a yellow tinted gelatinous mass that would become banana bread.

The blender working the butter and sugar was waiting for the bananas and eggs. Once added the aroma of the ingredients filled the air and took on a firmer texture. Slowly the flour mix was added. The dry flour melded in to become a batter of grayness. Scrap the sides until the scars of dried flour was gone. I pour this into two loaf pans and place in the oven.

Forty minutes later I removed the loafs of banana bread and cooled on a wire rack. The house smelled like home. I sat on the chair and closed my eyes. I was startled awake by a dream of which I have no memory.

Where was she? The aroma of banana bread was there that was no dream. The mist of sleep evaporated from my mind. I remembered, she is not coming home. Donna died six years ago.

It was still Sunday. It was still our home. There is no reason not to continue. I imagine she can smell the banana bread.