Archive for April, 2009

Photo distractions

Thursday, April 30th, 2009

sc00026e231

Last week Joann came down and brought this photo of all the neighborhood kids eating watermelon in our backyard in the summer of 1964.

The photo got Bette and Joann to talking about all those “kids” and remembering what it was like on Newport St., where the families were big, the houses small, and money was tight.   But somehow life was OK.  In fact, Bette says those were some of the happiest days in her life.

All the neighborhood mothers seemed united. The rules for the neighborhood kids were the rules, like somehow the parents had gotten together and made a pact, written a special code of conduct for that one block of that one street. Values, punishment and rewards seemed consistent from family to family.  Talk about a tribe.

Yet those same parents sure acted like kids, turning cold, unfinished basements into party spaces. Staying up late drinking beer and playing bridge on Friday nights. And let’s not forget that one father who put firecrackers in an outhouse during a summer vacation when we all migrated from Boston to NH. Sometimes we kids felt like the parents, yet we didn’t know what the rules were suppose to be.  So we just ran wild too.

On weeknights the mothers often were out the door as soon as fathers were home and kids were fed. I remember my mother taking evening sewing classes and making us such beautiful outfits. The hounds tooth skirt, coat and matching hat for Easter was one of my favs.  We couldn’t afford Filene’s but Bette made us originals.

See the 1964 watermelon photo has been good for Bette and all of us.

A good photograph is a wonderful distraction. It takes you somewhere else, far from the ‘mom-is-dying” reality. Photographs trigger all kinds of memories, mostly good, some not so good, but now is the time to talk about those too. Tick tock.

So forget about baking brownies. Dig through those old photo albums and bring one really great picture.

What’s your cancer caregiver soundtrack?

Tuesday, April 28th, 2009

Some days while caring for my mother I feel lost. Maybe disoriented is a better word.  There’s no predicting how she will be from one day to the next. I fear I’m letting my business colleagues down by spending too much time away from work. And then there’s my husband and 14-year-old son at home, probably eating pasta and no vegetables again for the fourth or seventh time this week.

Walks help.  But music helps more.  Some days the music allows me to wallow in my lostness while driving alone. The brooding is so indulgent and I couldn’t do it without the music. Other days my “cancer caregiver” soundtrack makes me feel strong and courageous and oh so positive. Bring it on, I can handle it.

Social workers advise caregivers to make sure they take care of themselves. Here’s the soundtrack that’s caring for me:

  • Mercy Angel by Brian Blade
  • And So It Goes by Bill Joel
  • Don’t Give Up by Kate Bush and Peter Gabriel
  • Trouble by Cat Stevens
  • Tenderly by Duke Ellington
  • Stay by Jackson Browne
  • Beauty Mark by Rufus Wainwright
  • The Way by Neil Young
  • Wholy Holy by Marvin Gaye
  • I Will Survive by Gloria Gaynor
  • The Surest Things Can Change by Gino Vannelli
  • Reach Out and I’ll Be There by The Four Tops
  • Friends by Elton John
  • A Song for You by Donny Hathaway
  • We Can’t Be Someone Else by Arling & Cameron
  • Angel by Aretha Franklin
  • You Get What You Give by New Radicals

Sick humor

Thursday, April 23rd, 2009

When half your head is scalped from neurosurgery, you’ve been told that your stage IV cancer has spread like wildfire, and your days are numbered, sometimes the best thing to do is take comfort in favorite jokes that are especially relevant.

When people see Bette, they are shocked at how different she looks and she can see that shock in their faces. She can deal with that.

What’s harder to deal with is when people say, “You look good.”

When Bette hears this she brings up one of her deceased husband’s favorite jokes.

“You know what they say. There are three stages of life. Youth, middle age, and ‘you look good.’”

Then she and we laugh off some of the reality.

Respecting otherworldy signs

Thursday, April 23rd, 2009

mans-hand-in-shadow Part of helping people with this dying process is shutting up and listening. And respecting  dreams, signs, and, who knows, maybe some sort of spirit guides hovering around.

The “who knows” part is important.  I’ve never been one of those touchy-feely, new age kind of people. Logic has been my North Star. But when the dying person shares special dreams or signs,  we must put aside our biases, and honor those signs.   This is their journey and we’re here to help, not judge.

Bette wanted to share  a story, but then stopped and said, “Oh, it’s probably foolishness. I’m too embarrassed to talk about it.”

But clearly she wanted to talk about it.

“The night your father died I felt someone put an arm around my shoulder and give me a hug. I felt the warmth of that arm. It wasn’t like a dream. Today when I was napping that same arm hugged me three times.  Now I don’t feel as scared about what’s going to happen. I know I’m dying and it’s OK.”

And I realized by listening respectfully I made it more OK.

The joy of receiving cards and notes

Thursday, April 23rd, 2009

envelope and notePeople who are very ill love receiving cards and notes.  It’s a simple gesture we can all do for those who are dying, whether we’re close to the person or are just work, neighborhood or church acquaintances.

“Have you seen all these cards,” Bette asked me. “It’s just unbelievable. I never knew there were so many people who cared so much about me. Aside from my family, I’m most proud about these cards, these people who have written to me. I just never knew that there were this many people in my life.”

Bette saw a blizzard of cards when people first learned of her terminal cancer prognosis. That’s when we all feel compelled to “do something.”

Another  lesson for me is to keep sending cards. Many days the ill person wants no visitors, is too weak to talk on the phone, but so appreciates opening a new card and receiving a warm “Hi” from a friend.

Tell her how much you love her

Thursday, April 23rd, 2009

Now is the time to tell the dying person how much he or she  has meant to you, how much you have learned from them. This is such a gift. A BIG, BIG gift.

It needn’t be long. Just a short note.

My mother keeps just such a card from her niece Amy on her bedroom bureau, sharing it selectively as it turns on the tears machine when you read it, and some days Bette just can’t handle weepiness.

Dear Aunt Bette,

I am so sad. I can’t imagine what life is going to be without you. My sisters and I have learned so much from you on how to be the best aunt.

You and Uncle Jim have always been such important people in my life and I will always make sure that I care for and love my nieces and nephews the way you and Uncle Jim have done for us. When I remember what you’ve done for me and do the same with my neices and nephews I will smile.

Love you,

Amy

Praying over bag of chemo medicine

Wednesday, April 22nd, 2009

chemo-bag The best way to help those who are sick is to just do what they ask us to. My friend Leslie shares this beautiful story about helping a friend with cancer.

The day I took  her to the chemo appointment, I was struck by how direct she was about what she needed for her own health. I will never forget the feeling I had when she asked me to pray with her over her bag of chemo medicine.

I was a little embarrassed because I’m not a big fan of praying in public. But here she was, oblivious to any embarrassment or self-conciousness. She didn’t care what anyone thought. She knew the stakes and was completely focused on doing whatever it took to save her life.

So, of course I agreed to pray with her. We took that bag of chemo and held it together. I don’t know what she prayed for but I begged God to infuse that medicine with love and healing to save her life. In that moment, I saw a woman literally fighting to say on this earth with her children. And so I prayed as hard as I could and kept praying for her everyday.

Until that point, I had imagined that I had a very long, almost infinite, corridor of life ahead of me. I really didn’t give death a thought. There was plenty of time and no urgency.  My dear friend, with so little time left and so much that she wanted to do, reminded me that every single moment of life is precious. She helped to remind me to really, really love every single moment of it.

On death and dying

Wednesday, April 22nd, 2009

During our early morning walk I told Greg how lucky I felt to spend time with my mother, knowing she was dying, and having time to talk about things that we’ve perhaps never talked about.

Greg’s reaction was, “Maybe we should all be talking about those things every day. Not waiting.”

Then I saw this beautiful video from Therese Borchard who blogs the BeyondBlue column over at the BeliefNet blog. Enjoy.

Managing visits

Wednesday, April 22nd, 2009

clock Some days dying people can handle visits, other days they’re just too weak and tired. We’re learning that the on-duty caregiver needs to politely police visits.

This means knowing when to say, “not today.”  Or being clear on the best time to visit and how long the visit should last.

Yesterday my mother’s friend Barbara called to see if she could come over for “cocktail hour” — Bette is usually up from 5- 7:30 p.m.  having a martini and dinner.  Bette shook her head OK while I was on the phone with Barbara and I said an hour was too much but 20 minutes would be just fine.

Related is learning how to wrap up the visit, gently — and sometimes more directly — giving the signal that it’s time to go.

We find that Bette wants to be available to people who care so much about her. We also find that she overextends herself and appreciates someone else doing the polite policing.  The three questions we ask her:

  • So -and-so wants to stop by today. Are you up for it? (Yes/No) (Note people with terminal cancer have up days and down days.  It’s almost impossible to plan visits in advance as the person can’t predict how he or she will be feeling. Don’t be offended if people tell you that they can’t plan ahead and to please call on the day you’d like to visit. )
  • Should we suggest 10 a.m. – noon or 5-6 p.m.? (Times she generally feels OK)
  • What do you think — is this a 15, 30 or 45 minutes visit?

Thelma and Louise hit the road, again

Monday, April 20th, 2009

img_0016 Bette on her beloved beach

I really shouldn’t drive.  I’ve been half blind for 18 years, but the sun was out, and the car had gas.  My mother really shouldn’t drive either; she is half blind on the other side. Two bad brains equals one good brain. We left for the beach.

The sun was high, the wind was low. We drove slowly.  The beach was empty. She is so stubborn that she practiced her balance walking on the sand. We got to the water’s edge, she held my arm, stooped down, put her hand in the water, and sighed. Followed by a survey of the beach, and the Vineyard in the horizon, we decided it was a good day.

Whenever it is my mother and me, without the others who would recommend that they drive, we get in the car posing as Thelma and Louise.  We’re not sure who is who. We know the beach is there and it is waiting for us to declare the day is good.

Posted by Nancy Kelly

Boo Boo’s mother-in-law’s next door neighbor’s cousin had cancer too

Monday, April 20th, 2009

When it came time to spread the news of my mother’s illness to my co-workers and friends, I wasn’t sure what to say, and how to say it, and didn’t want the spot light on me.

I shouldn’t have been concerned.  Everyone knows someone who knows someone who had cancer.  You share your news and people say, “You know, Boo Boo’s mother-in-law’s next door neighbor’s cousin who had lung cancer and went to a hospital and was wicked sick so she  got chemotherapy that made her bald,  then died, and her daughter was wicked exhausted so be careful and make sure you take care of yourself.”

This was not easy to hear. I didn’t care about Boo Boo. Still don’t. Never will.

One person listened to me — and listened hard. Then kind words of advice followed and I think of them when I sit quietly with my mother. “Ask your mother questions. Find out as much as you can about her. Ask what her life has been like.”

Everyone’s story and experience is different. Listen. Don’t talk.

Posted by Nancy Kelly

There will be angry words

Monday, April 20th, 2009

stopit

My younger sister Renie, a successful, buttoned-up business professional, can juggle a zillion things at once. One Friday she called to report on Mom’s meeting with the oncologist in Boston.

“We had a good meeting with the oncologist today. He thinks radiology can shrink the brain tumors and then chemo can help with the lung cancer. The next appointment is ….”

“Stop, Renie,” I snapped. “Maybe all this treatment isn’t right. Maybe it’s going to make Mom sicker and ruin her quality of life, the one thing she wants.”

Radio silence.

Renie was angry. She had taken the day off from work and shepherded Bette through all kinds of appointments, taking notes, being there. What right did I, who wasn’t there, have to contradict her?

We icily closed the conversation, saying we’d talk later.

I felt awful. Renie’s take-charge approach felt controlling to me that day, too black-and-white, too decisive. Like she was in control and not Bette. And, of course, I’m sure I came across as the bossy older sister, always taking over, questioning others’ opinions.

I sent an email the next day apologizing about cutting her off. I thanked her for all she was doing, acknowledging how hard it is for all of us trying to find our way in helping Mom. She wrote back:

Lo,
I know you were reacting to the news – it’s OK to vent on me!
I spoke to the Oncologist this morning and will try to reach the Nurse
Practitioner this afternoon to get more insight on the chemo side
effects, etc.
R

There will be angry words. Pain and sorrow can bring out our ugly sides. Let it go. Let it go. Keep those you love close. Together you’ll be stronger. And you’re going to need all that strength in the coming weeks and months.

Assign people what they’re good at

Monday, April 20th, 2009

Everyone wants to help out but most don’t know what to do. They feel bad sitting by passively.  We, the immediate caregivers, shouldn’t try to do everything. More importantly, we have to help others contribute.

One way to do this is to figure out what people are good at, and feel comfortable doing, and ask them to do those things.

My brother David, for example, is a hard working guy of few words. He’s not good sitting around and “visiting.”  So we ask him to drive people places, like driving our sister Susan the two hours from the Cape to the Providence airport.

Jim, our other brother, has been getting Mom’s house ready for spring, staining the deck, fixing screens, brining out some summer furniture.  Susan, while up here from North Carolina, cleaned inside and out.

We asked Lew, Mom’s brother, to get the car fixed, figuring out things with the auto body shop and the insurance company. What a help to get the car back.

People really are dying to help. If the head honcho caregivers step back for a minute, you can figure out all kinds of small but helpful ways for people to pitch in. The more people are involved the more the positive juju grows all around.

Staying up all night

Monday, April 20th, 2009

sleeping beauty

Bette was having a tough time sleeping the first week home after neurosurgery. The medicine made her mouth dry. Her neck ached from sleeping on her side in a weird way that wouldn’t be putting pressure on those 56 staples holding her skull together.

Petie, her sister, was staying overnight and heard Bette moving around in the middle of the night. She got up and went down to Mom’s room and got into bed with her. Mom couldn’t sleep, wasn’t comfortable.

They lay in bed together, sister and sister. Talking. Not thinking about time. Not worrying about not sleeping Just being together.

What a comfort.  For both.

In times like this it’s often good to forget about time.

Enough with the banana bread

Monday, April 20th, 2009

banana-bread

  • Birthdays: cake
  • New Year’s: champagne
  • Terminal cancer diagnosis: banana bread?!!

OK, I know this sounds kind of rude and ungrateful. But hold off on the banana bread. Sick people rarely have a sweet tooth and the caregiver rarely can eat all those banana breads.

The week Bette got home from Mass General Hospital, people kept stopping by the house and leaving banana bread. We must have had nine loaves by the end of the week, and three big plates of brownies.  It seemed like the banana bread was reproducing. Every morning there would be more. I came down to the kitchen, made coffee, and pondered, “What should I do with the banana bread?”

We started freezing it. But then there was no room in the freezer for real food.

Clearly stressed about the mushrooming BB’s and feeling guilty about throwing kind intentions into the trash, I asked one of my mother’s friends, “Why are people giving us so much banana bread?”

“It’s so that you have something on hand to give people when people visit,” she explained.

“But Bette is too sick for visitors. I’m the only one here.”

“Oh.”

When people die, there are a lot of people around who need to be fed. When people are dying at home and not wanting any visitors, there’s not much need for banana bread.

A better option would be to ask the caregiver what food, from what local stores would be appreciated.  Really, it’s OK to ask.  When I’m with my mother these days the last thing I want to do is to have to grocery shop and cook.  But I need to make sure she eats, and I’m always hungry.

To be able to have the squash and steak tips from Roche Brothers is heaven.  Better yet, put us on a steady meal delivery from Chef Ralph’s Mad Platter. And even better, instead of saying, “Let me know how I can help,” offer to organize friends around pitching in for weekly meals from a local place like the Mad Platter is for us.

The ill person needs to eat to keep some strength and be able to tolerate medications; the caregiver needs to eat to stay healthy to be able to care.

Just not banana bread.  :)

I should have called

Monday, April 20th, 2009

“I know I should have called you a few weeks ago, but I just didn’t know what to say.”

We’ve heard that from several people. And, to be honest, we’ve been in the same situation where we didn’t know what to say to people who had just been diagnosed with serious illnesses. So we just didn’t call. MISTAKE.

Here’s the deal. Just call people who have gotten tough news. Don’t worry about what to say. Just say, ” I heard the news and want to tell you I’m thinking of you.”

Better yet, write a card or a cool post card and drop it in the mail.

That small gesture means so much.

Magical thinking

Monday, April 20th, 2009

Asparagus Hollandaise

Heads up: be on the lookout for how to help people by sharing the truth, and making it OK for them.

Our sensitive, kind cousin Amy sent an email to me about an asparagus treatment for cancer that she thought might help Bette feel better.

My first reaction was, “If only.”  The second was, “Amy doesn’t know how very sick Bette is, that we’re in the final lap here.”

So I sent Amy a note to tell her. She deserves to know. She wrote back that she had no idea that Mom’s illness was so far along. And that she was thankful to know.

What I learned from this is that helping people means being truthful. By letting them know that the person you all love knows the facts and is OK with dying soon – and that you hope they can be too.

***********************************************************

Several years ago, I learned of the discovery of Richard R.Vensal, D.D.S. that asparagus might cure cancer. Since then, I have worked with him on his project. We have accumulated a number of favourable case histories.

We would have other case histories but the medical establishment has interfered with our obtaining some of the records. I am therefore appealing to readers to spread this good news and help us to gather a large number of case histories that will overwhelm the medical skeptics about this unbelievably simple and natural remedy. For the treatment, asparagus should be cooked before using, and therefore canned asparagus is just as good as fresh.

* * PROCEDURE:

1) Place the cooked asparagus in a blender and liquefy to make a puree, and store in the refrigerator.

2) Give the patient 4 full tablespoons twice daily, morning and evening.

Patients usually show some improvement in from 2-4 weeks. It can be diluted with water and used as a cold or hot drink. This suggested dosage is based on present experience, but certainly larger amounts can do no harm.

Holding hands

Sunday, April 19th, 2009

holding-hands

Easter was a tough day for Bette. She knew it would be the last holiday with her family, all those big and little grandchildren, nieces and nephews, children, sister, brothers, in-laws and out-laws. (As we lovingly refer to some of the in-laws.)

But she rallied, despite her exhaustion, despite feeling melancholy, despite the swelling in her legs.

She wore a beautiful new robin’s egg blue vest, the same color of her eyes, got the eyeliner on remarkably even, and wore a perfect rose colored lipstick. Though thin she looked like a healthy person.

The afternoon visiting at her brother’s was tough.  She was so tired.  Worse was that she felt like people were fawning over her and paying their last respects.

I sat down on the couch next to her and asked, “You doing OK?”

“I feel like I should be wearing a sign that says ‘Last Chance,’” she said.

I took her hand and held it.

“Thank you, that’s what I need,” she said.

When we protect and reassure our babies we hold their hands. When we are in love we hold our lovers’ hands, silently signaling our commitment, our devotion, our caring. But somehow we fall out of the habit of holding hands. We forget the magic of such a simple gesture.

I hope I can hold Bette’s hand for a few more months.

The four words to never to say to a cancer patient

Sunday, April 19th, 2009

“You will be fine.”

Oops. If you don’t really know the medical situation, you may not want to use those four words.  Especially if the prognosis is terminal.

Bette, whose prognosis is terminal, went for blood tests one day. The medical lab was in the same building as the local senior center where she had been a volunteer, and she ran into several acquaintances.

“Oh I heard you have been sick. You will be fine.”  One, two, three people expressed these four words, trying to be reassuring, clearly not knowing how very sick Bette is.

Going back for tests another day, a woman who had been a volunteer with Bette simply said, “I want you to know how much we miss you. I always enjoyed your company.”

Nice.

Thoughts and prayers

Sunday, April 19th, 2009

(WARNING: Please don’t read this post if you’re easily offended.)

“Our thoughts and prayers are with you,” said almost every card and call that came to my mother and my sisters and brothers and I once the word of Bette’s terminal cancer prognosis got around.

Clearly get-well cards weren’t appropriate. Nor were sympathy cards.

So people wrote messages in lovely blank notecards, the most common being, “Our thoughts and prayers are with you. Please let us know how we can help.”

There was an avalanche of religious cards. Prayer cards. Special masses. Cards about saints who we-who-had-rarely- gone-to-Sunday-School had ever heard of.  One person even sent a small gift — a plastic night-light of the Virgin Mary.

My sister Susan, from the Bible belt, was especially showered with “thoughts and prayers.”

The exception was her teaching partner. When Susan told Jo the news, Jo in her Australian accent loudly blurted, “Oh, fuck.”

At which point Susan and Jo both choked and cried.   Jo was the first person to say what we felt, what we wanted to say, what we wanted to hear. Oh, fuck, our always youthful, always strong 74 year-old mother has just learned out of the blue that she’s going to die soon.  Fuck, fuck, fuck.

Until this I probably sent “thoughts and prayers” to people too. Empathy is loosely defined as ‘putting ourselves in the other people’s shoes.’ Know that the person dying and those closest to her may feel like their shoes are a size too small and the blisters are killer. Instead of neutral niceties they may welcome the chance to be able to talk with you about how awful it all is.

Advocating for martinis

Sunday, April 19th, 2009

martini

We were in a rush and feeling overwhelmed and disorganized that Thursday morning at Mass General.

It had been six days since Bette had had major neurosurgery to remove the largest of her brain tumors, and less than 24 hours since she learned that the real source of her cancer was in her lungs, from which the cancer had spread to her brain.  That news was a crushing blow.  We had thought it was just brain tumors and the surgery had removed the biggest of those tumors. What now?

Well, the most immediate “what now” was that the nurse came in the room and announced that my mother was being discharged. She could go home.

“Today? With all these staples in my head?” Bette asked. (There were 56 of those suckers in the back of her head, crusted with dried blood, still at great risk of infection.)

“Yes, now. Do you have someone who can drive you to the Cape?”

Bette had no clothes, but I had a car and we were making a break. Getting out of sicksville to bring her to the home near the beach that she built and loved so much.

We figured out how to wrap her up in blankets over those flimsy little hospital johnnies, and decided that not having shoes wasn’t going to be an issue.  The hospital socks would keep her feet warm , I’d pull the car up to the hospital door and we’d get help getting her in the car, avoiding the March slush.  I called my uncle to ask him to turn on the heat at mom’s house. The nurse came in with pages of post-op instructions, lists of medications, a schedule for follow up visits.  It was overwhelming.

Then my sister Nancy, a nurse practitioner, arrived, followed by the neurosurgeon, who also wanted to review all the instructions with Bette.

Fortunately, Nancy is a brilliant medical professional and was able to help my mother understand the implications of what the doctor was explaining, and reassured us that she’d be down the Cape the next day to help sort out all the medications.

“Is there anything else,” the neurosurgeon asked.

“Is it alright for Bette to have a martini,” asked Nancy.

“A martini?”

“Yes,” said Nancy. ” My mother has always enjoyed a martini at night before dinner. Can she drink a martini?”

“Well, er, ah, I don’t know.  I guess it can’t do any harm,” replied the doctor.

With that my mother thanked the surgeon for all he had done for her, got in the wheelchair, and away we went, speeding down Boston’s southeast expressway before rush hour, feeling like a couple of offbeat Thelma and Louises.

When we got to my mother’s small town early that evening we stopped at the pharmacy to get the drugs, the grocery store to get gourmet take out, and then scooted to the liquor store to get some vermouth and vodka.

At home that night Bette was elated. She was home, able to sleep in her own bed, her own quiet bedroom. No doctors, no tests, no other sick people around.  She lifted up her martini glass and toasted, “To Home.”

I lifted my beer and toasted. “To Nancy, who knows all the right medical questions to ask.”

Now that’s a patient advocate.