How “R” You?

Life isn't a predictable flow of time, which affects all of us in the same way. Consider the word ‘resiliency’ which is that characteristic which helps us cope with the ups and downs that are normal in many lives. When people experience major challenges, that flexibility and adaptability offers some strength—but we know it doesn’t make problems go away. Perhaps that generality doesn’t help you at your time of life and health. You may be like so many of us for whom life goes along pretty well, but little things may cause some underlying concerns, worry, and anxiety. Perhaps you may be anxious when the electric bill comes every month, or when the bank statement arrives; or perhaps your arthritis is getting worse and you fear losing your mobility. Or perhaps you haven’t heard from your son in a while. Perhaps it’s your reaction to the coming winter’s gray cold days. Little things can add up for us to turn into quite a load. Resiliency doesn’t only help us for the big stuff; it also helps with the smaller daily parts of our lives.

How do you respond when someone says to you “Hi, how are you?” You know they don’t actually want to know how you are – it’s just a comment of social courtesy to start of conversation. Let’s think about that question, about what it really implies and how we might respond in kindness and concern. I think we can focus on those “R” words, beginning with ‘resiliency.’

Resiliency: What is it that helps us recover from, or adjust to misfortune or change? For little children it might be the teddy bear, or the blanket, or a hug from a parent. As we get older, perhaps it becomes a prayer shawl or quiet time in a favorite place with a cup of tea. It may be a visit with a trusted friend, gardening, reading or a hobby that is relaxing for us. Whatever helps quiet the ‘noise’ of life is good to incorporate into a daily routine. It then becomes a good habit, on which to draw if/when tough things come along.

Regular routine: Cluttered and chaotic lives, with busy schedules, and cluttered surroundings disturb us in our inner core. There might be too much stimulation to think clearly. It’s difficult to remember things when we don’t know where something is, or what’s on the calendar from one day to the next. Perhaps this part of your life needs some work.

Reasons: There are stresses that are common, generally involving loss. There is loss of a loved one, loss of health, loss of independence, loss of self-esteem, loss of dignity, loss of hope. People lose jobs, homes, marriages, strength. Perhaps there have been small losses that accumulate, and then when the next little loss comes along, it tips the person over the edge of tolerance – and resiliency fails. You’ve heard the expression that someone is ‘having a bad hair day.’ That may be the last straw in a long line of frustrations for someone.

Request: Let’s practice asking for what we need. Sometimes that is uncomfortable for us to do because we don’t like to show our vulnerability. When a friend asks “how are you?” consider how you might really ask for what you need or express what’s concerning you. “I’m looking for a ride. . . I need someone to talk with. . .I goofed up my last exam” might all be responses that would indicate openness to additional support and conversation.

Reveal: Being authentic in relationships builds trust. When someone reveals true thoughts and feelings, it encourages the same in others. It suggests safety in the confidentiality and concern of friendship.

React: Showing concern does not suggest than we can solve someone’s problem. Rather, it shows interest and concern for the person. “I’m sorry to hear that. . .tell me more. . .why is that?” are responses that may fit the situation.

Reverse: There is the reversal in someone’s life when a situation just turns around, like a reversal of “fortune” which can be devastating. There are other times when we have the opportunity to reverse a situation in which a difficulty can be overcome or shared.

Regret and remorse: We don’t get to go through our lives without wishing we had done some things differently in the past. There may be past mistakes for which we feel deeply ashamed. Sometimes we need to ask forgiveness and make amends to another person, to ourselves, or to God. Let go of that mistake, and more on with resolve.

Realistic expectations: Perhaps these ideas sound pertinent to the situation at hand. Often a person will be unable or unwilling to see the facts of the situation because of lack of complete information. That’s when it may be a good idea to have a visit with whatever professionals might be available. In some of the examples given here, it might be a conference with a physician, with an attorney, a financial expert, one of the pastors, or someone in your family.

Regroup: A good friend of mine has a phrase that has helped me overcome regret and remorse: it’s simply ‘forget it, and move on.’ Resume normal life, move on to other things.

Reaffirm: Assess your gifts, your strengths, those things that go well for you. List them on paper or keep them in mind, acknowledge them, be grateful for them. Extend that arm of yours, and reach up and pat yourself on the back. Take every opportunity to do that for others when you see good things in them.  God reaffirms us in our faith, providing strength for each day.

Retrospect: Looking back can be useful; it provides grounds for the above thoughts on reaffirmation.  Tell your story of life. Consider history of your family, community, church, country. Review it, write it down if you are able to do so.

Renew: Restore, refresh, and revive. Be strong when you can, reach out when you need strength.  Reach out in relationship and friendship to others. Live as much as possible as one of grace. And finally, 

Rejoice! Give thanks and be of good cheer whenever possible. As people of God, we hold fast to what is good, and live each day in faith, hope, and love.

CHOICES that matter most

As strong, healthy, decisive individuals, we generally value our autonomy above all. This is a good thing. However, it often is short-sighted to assume that our lives will not change, or that our decisions of the past will apply in all future situations.

There is no easy way to plan for future health care choices. It's a process that involves thinking and talking about complex and sensitive issues. If you follow the news, you have heard about some situations in which choices are left up to others and you might wonder how or why that was allowed to happen. Often there are no warnings of devastating changes in health status; at other times, there is a long illness which may or may not give a person time to consider options and make one's own decisions.

Let me be clear to say that this is not referring to one's last will and testament, finances, property ownership or assets. This is about who will speak for you when you are no longer able to speak for yourself. Who will be your agent, who will work with your healthcare team for your best interest, This is about that inevitable transition that we all will come to – from this life to Life Eternal. The end of life only rarely happens in 'the blink of an eye.'

The death due to ALS of a notable dean of the University of St Thomas is well-documented in the book “We Know How this Ends,” written by Bruce Kramer, with Cathy Wurzer of MPR. There were many decisions about quality of life during his prolonged illness; and he had the courage to write about them for the benefit of others who may face similar situations.

As your parish nurse, I have worked in the settings of healthcare involving many difficult decisions required of patients, their families, their physicians, their other healthcare providers. There are no easy ways to plan for future health care choices; it's a process that involves thinking and talking about complex and sensitive issues. People have the right to have the healthcare team tell them about medical choices, the risks and the benefits of each of the options, in terminology that is understandable and clear. The patient has the right to accept or to decline these choices.

The Advanced Care Planning Guide, of Honoring Choices MN, helps a person share thoughts, feelings, concerns with the healthcare team, family, friends, and spiritual advisors. Consider the health conditions that you may have now, or may likely encounter in the future; and consider the treatment options currently in practice. Whatever your personal decisions are about certain treatments, it's important that you discuss your point of view with the people closest to you. It is also a good idea to put your choices in writing.

It's challenging to think about having to make these decisions, and it's more difficult to make decisions when you don't know what you want because you've never considered what you might want. Additional information and forms to complete are available at www.honoringchoices.org.

THE DOCTOR IS IN . . .

Charles Schultz created the “Peanuts” cartoons of years past, and perhaps you recall the familiar Lucy, sitting curbside, in a type of converted lemonade stand, with a sign overhead, proclaiming “The Doctor is IN” for the purpose of giving advice to the ever-discouraged, ever-confused, ever-anxious Charlie Brown.

I haven't seen any MDs with curbside consultation stands, and one can say that we might wish our MD would be so easily accessible. Let me attempt to describe various types of healthcare delivery systems, and a consumer's guide for discerning which to select among all the choices.

There are many categories of providers of healthcare, and different medical specialties among physicians. There are also various settings in which one might receive health care. In the case of healthy individuals, their health care is usually provided by a family practice physician or a general practice physician. When the patient has chronic conditions that impact overall health, it is common that physicians with specialty designations also participate in care, such as an allergist or an orthopedist. As one's health status involves more than one or two physicians, most often one of them is designated as the primary care physician (PCP); often this is an internal medicine specialist.  WORD TO THE WISE, if your care is not centered within one healthcare provider group exclusively, BE SURE that each physician you visit has a complete list of all your medications and vitamin supplements, as well as your allergy list.  Do not assume that your eye doctor doesn't need to know about your blood pressure medications, for example. When you do see physicians at different locations, ask to sign a release of information form so that the health information from another doctor will be shared with your PCP. This is for your own safety and on-going consistency in care, over time.

Some thoughts on establishing care with a primary care physician for yourself and your family: None of us makes plans to be sick or sustain an injury. No one intends to break a leg—that's why such happenings are called accidents. And accidents can happen at any time, to someone of any age. Often someone goes to the first appointment available at any clinic to find relief for a cold, a rash, or hay fever. If, then, in two weeks the person isn't improved, s/he may go to a different clinic because it's near home or work, and s/he may not report the treatment given before, which results in first-line treatment given a second time---which doesn't work any better than the first time. To the contrary, going to the same provider allows for more in-depth assessment and reconsideration for a change in the approach to treatment.

None of us has any assurance that our health needs will occur during “normal business hours” for a health care clinic. Those accidents and sudden-onset symptoms can be those things that require immediate care.

There are urgent care centers that are located within a larger clinic or hospital; there are other urgent care centers that are 'free-standing' or located within a Target or Walgreen's store, for example. Urgent care services are medically necessary services which are not life-threatening but need some attention within 24 hours. An urgent care center does not typically have anything more than very basic diagnostic equipment, for evaluating basic lab work and uncomplicated x-rays. Examples of some conditions that are treated in urgent care: allergic reactions, rashes, sore throat, sinus infections, pink eye, ear infection, bug bites, sprains, lacerations, migraine, diarrhea, vomiting.

It's important to keep an Emergency Department free of 'busy work' that should have gone to urgent care, so that the Emergency Department can focus on true emergencies. Statistics show that about 30% of cases in the Emergency Department could have been successfully treated in urgent care. So how do you decide? Here are some more guidelines for situations that should go directly to ER:  chest pain or other heart attack symptoms – call 911; multiple broken bones, or bones protruding through the skin; head injuries with or without multiple trauma, loss of consciousness, severe headache, sudden vision loss; overdose; suicide attempt; severe bleeding; poisoning.

A word about 911 and ambulance transportation:  Especially with symptoms of heart attack or stroke, do NOT drive the person to the hospital in your own car!  I cannot emphasize this enough.  The reason for this is that the ambulance has supplemental oxygen which immediately begins treatment for these potentially serious conditions; in addition, the ambulance will place a heart monitor on the person and that information will be transmitted to the destination emergency facility so diagnosis begins enroute by the staff in the ER.  Also, the ambulance has emergency medications that may save the life of the patient before arriving at the ER. Similarly, with these symptoms as well as possible fractures, the ambulance personnel also know which ER is most quickly available without delay, i.e. shortest “wait time.”

It is important to pay attention to, and comply with, your home-going instructions from urgent care, emergency care, or hospitalization. Most often you will be instructed to follow up with your personal physician. If you don't have one, this is the motivation to schedule an appointment at the clinic of your choice to establish care. The reason for this follow up is that there frequently can be complications of your condition which would have been symptomatic within that period of time, generally one-to-two weeks.

There is one additional healthcare provider to keep in mind. The larger orthopedic (bone) specialty clinics in the Twin Cities metro area have their own Urgent Care facilities fully staffed with x-ray and MRI capabilities, and with physicians to provide diagnosis and treatment on-site. Hennepin County Medical Center (HCMC) has their Fast Track Ortho Clinic for acute injuries and/or fractures. That department is open Monday through Thursday from 1 p.m.- 8 p.m., and Friday from 1 p.m. - 5 p.m. After those hours of service, HCMC Emergency Department will assess and treat orthopedic injuries. Twin Cities Orthopedics has several clinics in the metro area including Edina; their Urgent Care facility hours are 8 a.m- 8 p.m. Walk ins are welcome. TRIA, an orthopedic specialty clinic, also has urgent care services 8 a.m.-8 p.m. Walk-ins welcome there, as well. It is this writer's recommendation that an injury with suspected fracture be evaluated and treated at one of the orthopedic specialty urgent care facilities; it saves a lot of time, and frequently avoids a secondary referral.

Charlie Brown, his friend Lucy, and the 'Peanuts' gang, together with your parish nurse,

“The Doctor is IN.”