Tag Archives: hospice

Solo endeavor?

It was great fun to be back in person, in Philadelphia, reading poetry aloud. Prepping for the performance made me aware, though, that I have no current obsession to mull upon; that may be why I have not been writing many poems of late. However, I recently felt inspired by Lesley Wheeler’s blog post including some prompts from poets. Prompts! Of course. Those are ways into writing when writing has not supplied the writer with her own ways into writing.

Therefore, I’ll close another year of my blog with a piece I drafted using Lesley’s conjunctions prompt. What resulted from the free-write surprised me, which is a good thing (it’s fun when I surprise myself, though this gets a bit dark toward the close–but dark contains interesting objects). And many thanks to Lesley and to the other poets whose prompts she shared. It’s likely I will keep working with them until my next poetic preoccupation.

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So I’m tired of hearing people start their sentences with “So” on podcasts and the radio and TV, “so” a verbal tic, a word instead of “um,” which serves the same purpose but admits, more humbly, of uncertainty, which says I am pausing to gather my thoughts before speaking; whereas “So” sets up an explanation leading to opinion or argument, or so it seems to me.

So I’m sitting on my back porch even though it is late December, clouds gathering over bare trees. I hear woodpeckers deepening holes in trees, a rat-a-tat drill, and white-breasted nuthatches loud along the woodlot, and I ponder emerald ash borers and climate change and how to handle human aging in a capitalist society.

So what I wonder is “Am I afraid?” Some questions possess a looming quality, I guess this is one such. In my wicker chair, in my own backyard, no. Not afraid. The mood’s serene, no tightness in my chest no racing heart, not even facing death–as we all must do, though most of us refuse. Where are you going with this, Writer?

So all I’m saying is, I have fears about the future yes but not about dying, because dying I will face alone. Even when loved ones can be beside us, we are not an us when death comes. Each dies to their ego alone, interior to the world, most alone at death no matter who surrounds us.

So why, then, do I volunteer for hospice work, where the goal is not only to alleviate some of the pain but also to keep people from dying unaccompanied? My reasons are complicated, people are complicated. So let me just say that having been present when human beings die, that passage may not necessarily be a lonely one. But it is accomplished alone.

Miscellany

I reside in one of the Pennsylvania counties under “shelter in place” advisory, but I can work from home; also, we live on almost 7 acres, so outdoors activities continue. The buds bloom. The insects waken, goldfinches molt to their bright yellow, the magnolia tree bursts into blossom. The meadow is muddy, and vernal pools appear in the hedgerows.

Today, a miscellany of links and virtual or reading-related forays.

My new chapbook, Barefoot Girls, can be purchased at https://prolificpress.com/bookstore/chapbook-series-c-14/barefoot-girls-by-ann-e-michael-p-317.html

(Here I am as a barefooted teenager)

bfg

1975, New Jersey, USA

Poets House is offering live workshops (video) and has a great archive of past readings. Check them out. https://poetshouse.org/

Dave Bonta continues to compile fascinating writing-related blog posts. From his site, you can link to many other poets and writers who are pondering pandemics and etc: https://www.vianegativa.us/2020/03/poetry-blog-digest-2020-week-12/

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Meanwhile, I am still making my way through the 910 pages of The William H. Gass Reader, a selection of some of the prolific writer-critic-novelist-philosopher’s essays and excerpts. I love his piece on the book as a container for consciousness, and I suspect I’ll be saying more about that in future.

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Two friends have come down with the coronavirus; it’s no joke, people, take the slow-down seriously and “level the curve.” Please.

Finally, here is a photo of the wonderful hospice staff at the in-patient unit where I volunteer (though, for now–no volunteers are permitted in the hospital to assist, so these folks are doing it all themselves, bless them!).

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❤   ❤   ❤

 

Agency

It’s a bad idea to get into gardening if one happens to be someone who requires complete control of things. Nature’s behavior, it turns out, manages seldom to be controllable by human beings. One reason I enjoy gardening is the chance to keep trying a new approach, a new variety, a new method; if I cannot control the environment, I may at least find an adaptation that works for awhile.

This year, it’s a short-season, baseball-sized melon I’m experimenting with, and potatoes grown in a bag, and hard beans in addition to haricorts vert, and a different set of heirloom tomatoes. The method I developed some years ago to deal with insect-borne and moisture-spread viruses on zucchini no longer works for me, alas. Next year I will try something else–because I do love grilled zucchini.

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Bounty

There’s a difference between control and agency, and I’ve been pondering this since the illness and recent death of a long-time friend and fellow writer. Agency, as it has come to be used in psycho-social circles, means having the freedom and the ability to make decisions. It’s not quite the same as controlling–it hasn’t the same aims behind it. Also, agency implies responsibility. Controlling people are more apt to place blame, whereas a person with agency makes choices and accepts the responsibility of those choices.

That’s the sort of person Bill was: gentle, quirky, humorous, exceptionally smart, persistent, and devoted to the people he loved and the causes for which he advocated. He decided what mattered to him, chose the sort of life he wanted to live, and took responsibility for those decisions even when other people might have wanted him to do otherwise. He made, and kept alive, connections and relationships. He worked on being a better self and a better citizen of the world.

When it became clear that two weeks of hospital treatment had made no difference in his illness, he chose to go home under hospice care. I wrote to a fellow member of our writers group that I was a little bit in shock but also unsurprised at his decision. She said that yes, Bill has always believed in agency.

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Agency is one of those terms, like mindfulness and intentionality, that can be overused by pop psychology and self-help best-sellers until it is nothing but a cliché.  The etymology tells us much, however:

agency (n.)

1650s, “active operation;” 1670s, “a mode of exerting power or producing effect,” from Medieval Latin agentia, abstract noun from Latin agentem (nominative agens) “effective, powerful,” present participle of agere “to set in motion, drive forward; to do, perform,” figuratively “incite to action; keep in movement” (from PIE root *ag- “to drive, draw out or forth, move”).  [Thanks to Etymology Online]

 

That would be my friend and critic Bill, drawing forth and setting in motion; effective, powerful, someone who could do and incite to action, and make wise and purposeful choices in his life.

Book review, mind review

My book group chose to read Michael Pollan’s latest: How To Change Your Mind. The subtitle says a lot: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. That’s a bundle of complicated concepts Pollan takes on, but he recognizes his task looms large and that he can only make forays into the many overlapping arenas the book explores.

His approach–he uses this in his other books and articles, too–is a mix of serious research and journalism (interviews, mostly) and personal inquiry and experiences. If you have read Second Nature or The Omnivore’s Dilemma, you might find this one to be a more “difficult book.” It is heavily documented and features neuroscience (brain pathways and structure, mostly), psychology, pharmacology, and chemistry (tryptamine-related molecules). Not to mention mushroom biology and mushroom hunting, and serum produced by plants, toads, and ergot.

What attracted my book group members to this text is its chapters on dying; as a hospice volunteer myself, and having read articles on the potential value of psychedelics among people with terminal illnesses, this part certainly interested me.

Pollan writes: “The uncanny authority of the psychedelic experience might help explain why so many cancer patients in the trials reported that their fear of death had lifted or at least abated: they had stared directly at death and come to know something about it, in a kind of dress rehearsal.”

These outcomes seem significant enough that we ought to find ways to employ them in our palliative care work. In my own, somewhat limited, experience with dying people, those who are less fearful of death–for whatever reason that may be–stay alert longer, respond better to palliative efforts (pain medicine, massage, positioning, and so on), and are more likely to comfort their loved ones. They die more “easily,” if dying can ever be called “easy.”

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Yet I found the parts of Pollan’s book which deal with the huge question of what consciousness is and where it resides most relevant to my own interests. Yes–that difficult neurobiology stuff. Pollan suggests, with the healthy pragmatism of the skeptic, that empirical approaches to consciousness based on the idea that “the brain is meat” (viz, medical science) are unlikely ever to explain consciousness fully or to anyone’s satisfaction. In other words, consciousness may possess a component one might name “spiritual.” Here is how he frames this concept:

“…it seems to me very likely that losing or shrinking the self would make anyone feel more ‘spiritual,’ however you choose to define the word, and that this is apt to make one feel better. The usual antonym for the word ‘spiritual’ is ‘material.’ That … is what I believed when I began this inquiry—that the whole issue with spirituality turned on a question of metaphysics. Now I’m inclined to think a much better and certainly more useful antonym for spiritual might be ‘egotistical.’ Self and Spirit define the opposite ends of a spectrum, but that spectrum needn’t reach clear to the heavens to have meaning for us. It can stay right here on earth. When the ego dissolves, so does a bounded conception not only of our self but of our self-interest. What emerges in its place is invariably a broader, more openhearted and altruistic—that is, more spiritual—idea of what matters in life. One in which a new sense of connection, or love…seems to figure prominently.”

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When I was much younger, I considered myself “spiritual.” I stopped using the term once I began a more serious exploration of my life and began to study philosophy, psychology, aesthetics, phenomenology, and consciousness more intentionally. But the crucial components–connection, relation to and with others (sentient and not), and love–those I have always understood as necessary. Even though my ego has never “dissolved” quite the way Pollan describes.

So maybe I can go back to considering myself somewhat spiritual. At this moment in life, Nature and Others matter more than accomplishments and outcomes.

Welcome Spring, welcome Spirit. Namaste, Amen.

iris reticulata

iris reticulata

…Some rain must fall

Longfellow wrote that “Into each life some rain must fall” (“The Rainy Day“). The poem is an extended metaphor; here in my valley, the rain has been actual, physical, moist, sopping, wringing, drizzly, humid, soaking, and all the rest.

The metaphorical hasn’t been absent, either.

So this week, my post consists of other writers’ posts. Explore, please. All of these links offer much to enlighten the reader.

https://www.daletrumbore.com/unthinkable

https://marilynonaroll.wordpress.com/2018/09/03/now-hold-on-there-or-slowing-the-revision-process/

On first looking into Shenandoah’s submissions

https://www.vianegativa.us/2018/09/barberous/

http://www.writerintheworld.com/2018/09/03/cathedrals-and-yurts-a-reprint/

Language acquisition & its opposite

When my children were learning to talk, I developed a fascination with language  acquisition. The process of learning to communicate with other human beings in the lingua franca of the culture (speaking US English to adults) was taking place in front of me. I felt awed by the intelligence required to decipher language and delighted by the myriad ways the process and behavior unfolded. For about a year, I seriously considered enrolling in university to pursue a Master’s degree in some sort of language/linguistics-related discipline.

But I had two toddlers and lacked the energy, time, and money to devote to diligent scholarship of that sort. Instead, I took my usual autodidactic approach: reading and observing. One thing of vivid interest to me at the time was how differently my children each approached “learning to talk.” In retrospect, I recognize that their differences in personality and their differing cognitive strengths made significant impacts upon language acquisition, implementation, expression, and use.

ponchos~

 

At present, my interests in language revolve about the other end of the lifespan of human communication–the loss of language abilities as people age. The elderly Beloveds in my life are displaying markedly differing changes in how they experience, and express, cognitive gaps. Often the expression of such gaps appears in the way they speak.

This would be the opposite of language acquisition. Memory losses, or slower memory retrieval functions, are common to most adults over age 70; but those issues do not necessarily affect sentence structure, vocabulary, pronunciation, descriptive abilities, and emotive communication through language. Strokes, neurovascular constriction, and Alzheimer’s disease, among other physiological alterations, can exert marked effects on verbal and written communication, however. Hearing loss and diminished vision exacerbate these problems.

All too often, the human being seems “lost” beneath the symptoms or becomes isolated as a result of the immense challenges to human relationships we have taken for granted for decades of being relatively “non-impaired.”

The loss of language skills intrigues me as much as the acquisition; my readings in neuropsychology and neurobiology have taught me that there is so much yet to learn about the brain and how it processes–well, almost everything (but my special interest is communication).

And my experience with people who are aging, or in some cases–my hospice volunteer work–dying, demonstrates on a personal or anecdotal level how uniquely individual each one of us is. How we communicate, how we express ourselves, our neurological processes, our physiology, temperament, environment, genetic makeup…so gloriously complex, random, fascinating.

Maga

The late Edna Smith Michael in 1990. Her language skills stayed quite intact until her last hospitalization.

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Some recent reading–

Into the Silent Land: Travels in Neuropsychology (Paul Broks); Cure: A Journey into the Science of Mind over Body (Jo Marchant); The Language Instinct (Steven Pinker)

A post I put up awhile back contains my poem “Age as a Foreign Language.” Apropos here, I think.

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And no, I am not tempted to enroll in further formal study on this topic. But reading suggestions will be gratefully accepted!

 

Conditioning

In regards to my last post: I’ve conferred with some people who knew Jack Fisher, and I may have mis-remembered parts of the story. Although those who knew him agree it sounds like something he would do, no one else can place the painting that I recall. His daughter says it’s possible I saw a sketch or preliminary painting that Jack never completed. (She definitely recalls how much he abhorred the water tower!) If so, perhaps his talking about the possibilities of the composition made an impact on me, even if the work itself was a watercolor sketch that never made it to canvas. Entirely possible.

The point of my post remains the same, however–that “ugly” things can be understood in ways that may offer new perspectives on what we consider beautiful.

I guess what I am trying to get to qualifies as a kind of conditioning. That’s now a therapeutic approach to teaching people how to overcome, say, a phobia of airplanes or elevators. You put your toe in the water, so to speak, or learn about the thing that causes fear. And knowledge can overcome fear. Not always, but often.

Inadvertently, I discovered conditioning on my own, when I was about twelve. I decided to study some things I was afraid of–spiders, bees, darkness–and managed to unlearn the fear. It does not work with everything: I’m still acrophobic.

famous photo construction workers

‘Lunchtime Atop A Skyscraper’ Charles Ebbets, 1932

My biggest fear was one most human beings acknowledge–the fear of death. From the time I was quite small, I worried and feared and had trouble getting to sleep because my mind raced around the Big Unknown of what it would be like to die. Many years into my adult life, I decided to explore that fear through my usual method: self-education. I read novels and medical texts and philosophy and religious works in the process. Finally, after visiting an ICU many times during the serious illness of a best-beloved, I decided to sign up as a hospice volunteer.

It’s one way to face death–one sees a great deal of it in hospice care. But the education I received from other caregivers, from the program instructors, and from the patients and their families, has proven immensely valuable to me. Am I afraid of death? Well, sure; but fear of death (thanatophobia) no longer keeps me up nights. I possess a set of skills that helps me recognize how individual each death is–just as each life is. More important still? I treasure and value the small stuff more and am less anxious about the Big Unknown. It’s going to happen, so why agonize over it? This is conditioning. For me, anyway.

Conditioning does not have the same meaning as habituation, because conditioning requires learning and is more “mindful” than habituation. Habituation occurs when we just get accustomed to something and carry on; perhaps we repress our emotions or our values in order to do that carrying on. People can habituate to war, poverty, all kinds of pain, and can make not caring into a habit. We are amazing in our capacity to carry on, but it isn’t necessarily healthy. Getting into the habit of warfare, hatred, ignorance, hiding our feelings, or other hurtful behaviors is often easier than getting into more helpful habits like daily walks. I do not know why that is.

I am, however, endeavoring to condition myself to stay awake to new perspectives, to stay inquisitive, to plumb the world to find, if not beauty, at least understanding and compassion and gratitude. Maybe one day I will even manage to get that perspective from somewhere very, very high up…    [yikes!]

 

The morbid book group

← [FYI, readers, I have a poem in this anthology, which relates to this post.]

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A little over a year ago, I was invited to participate in a book discussion group that  focuses on texts that offer varying perspectives concerning health, surviving cancer, different cultural views of aging, and dying; books on “dying well,” hospice and palliative care, and on hope and healing; books on chronic pain and on neurology and the medical establishment, on birth traditions, on the history of medicine. We have also read The Tibetan Book of Living and Dying by Sogyal Rinpoche, Still Here by Ram Dass, and discussed books that have topics such as placebo effects, psychology, alternative medicines, the pharmaceutical industry, hospitals, the training and practice of doctors, and the death & dying ‘industries,’ including works by authors with personal and moral perspectives on how to live (and how to die). The people involved have included a pediatric palliative care expert, a NICU nurse, a hospice team spiritual counselor, a minister, a former nurse and massage therapist who’s a tai chi instructor, and others–most of us “of a certain age,” by which euphemism I mean we have been living through the experience of having parents in extreme old age and of having long-time friends who now contend with chronic or potentially fatal illnesses. At least one of us has survived cancer.

For a perspective on how most Americans view a serious study of such topics, I offer my husband’s assessment. He calls this “the morbid book group.”

In fact whenever I mention that I participate in a book group (a popular American activity), people ask me if the group has a theme; I tell them, “The theme is medicine, and wellness, and how we die.” And there’s inevitably a pause, and usually my friend asks, “Isn’t that kind of depressing?”

No. It has not been depressing, in fact. I have gained more than I can say from these books and from our small group discussions: information, perspective, philosophy, insight, dare I say wisdom? Not to mention freedom to talk about those things we tend to evade in polite conversation, the space in which to say “This really sucks” or “This saddens me deeply” or to ask, “What can we do?” The book selections have led to great discussions–and have helped me to forge some new friendships as well as to confront and accept different points of view on controversial issues surrounding health care. And death, yes (hello morbid books!), and grief, and–most of all–compassion.

Difficult books? Challenging reading? Have I ever shied from it? I relish exploring this kind of non-fiction-fact-science-ethics-cultural criticism. Participating in this book group is one of the highlights of my current life experience; it’s up there with my long-running poetry critique group and my MFA years in terms of transformational engagement and exchange of ideas.

Below, a list of some of the books we have read and talked about. Just in case any of my readers wish to begin a morbid book group of their own.

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Radical Remissions, Kelly A. Turner

Knocking on Heaven’s Door, Katy Butler

Buddha’s Brain, Rick Hanson

Death’s Door, Sandra Gilbert

Living with a Wild God, Barbara Ehrenreich

Still Here, Ram Dass

Being Mortal, Atul Gawande

The Anatomy of Hope, Jerome Groopman

The Tibetan Book of Living and Dying, Sogyal Rinpoche

Birth, Tina Cassidy

The Empathy Exams, Leslie Jamison

Counterclockwise, Ellen Langer

The Pain Chronicles, Melanie Thernstrom

Choosing Civility, P.M. Forni

Healing Spaces, Esther M. Sternberg

Die Wise, Stephen Jenkinson

…& more ahead, as we plumb consciousness, placebos, the medical hierarchy, and compassionate ways of living in the world. By the way, readers–suggestions for further readings are welcome!