Guilt's Pleasure and its Mayhem on Wellness

We are all susceptible to guilt. I remember, with astonishment, being a brand new mother and the feelings of guilt that panged me when my newborn threw up, or was gassy, or in any way unhappy.  I remember how shocking it was to feel this, not being used to that feeling, in that unfamiliar situation.  It was new and a somewhat ridiculous response, but there it was.

Depending on your cultural background, guilt can be a daily occurrence that riddles us with negativity, releasing stress hormones which significantly impact our health and wellness. Working with clients and my own self observations of guilt-visits indicates it is an indoctrination that has led to it becoming a fully ingrained habit.  A habit that is sapping our life force.  A habit established, probably, generations before us.

Something rings false when I feel that inclination to obliterate a feeling (usually negative) .  What is guilt good for?  Maybe it is the first bell rung asking for conscience to surface.  Maybe it is a precursor to remorse (I have my doubts on that one).  Mosquitoes serve a purpose (delectable food for birds and bats); so must guilt, I guess.

There is a difference between guilt and remorse.   Remorse is an actual feeling-meeting of "I can never do this again" and the sadness you did whatever you did to such an extent, your gut knows it can never happen again.  Remorse is a deep feeling that actually leads to behavior change.  Guilt is merely feeling bad, masks as having depth, with wringing of hands and "mea culpa", but the behavior associated to the action will usually be seen again and again.

There is some band-aid pleasure with guilt.  A superficial, "I feel bad-- that should do it, move on" kind of reaction.  We have guilt about accidents out of our control, tragedies somebody in us thinks we could have prevented even if they are an ocean and continent away, with people we often never met.  Guilt infiltrates what and how we eat, the way we spend money, our leisure time and relationships.  It undermines us, stresses us, brings bagfuls of negativity to our daily lives.  Yet, we minimize it, turn away and discount the hold it has on us.  There is some pleasure in the angst that is hard to let go of, some payback.

How to deal with guilt?  Guilt, like other mostly automatic negativity, doesn't appreciate the light.  Once an awareness and standing before it is possible, it atrophies quite naturally, slipping into the shadows whence it came.  So the work with guilt is bringing an awareness to it.  One might recognize it by the feeling in one's chest, the considerable tightening in a jaw or lower back.  One doesn't need to understand or analyze it.  But, we are required to be with it, breathe with it.  Find the silence in oneself while the manifestation of guilt begins to free fall.


Guilt and Worry.  Both so easy to discount, while being so wearing.  Is it because most of me hasn't been insistent enough on having a modicum of joy, hence allows for these large bouts of guilt/worry doses to transpire?  Or is it that most of me has confused a life worth living as having a lot of pain, sorrow, negativity; is it that introspection is mixed up with self-infliction?  Or maybe it truly is a life-long and generational indoctrination; a part of me, like a limb or an organ.  Yeah, it bothers me sometimes, but what are you going to do?

Guilt disables our sense of living without regret.  It ensures the cascade of stress hormones, taxing our bodies and our being.  A sense of well being and peace is the antidote to guilt.  But like what cutting oneself is for some people, the momentary pain of guilt is for others.  It feels sorta good.  Until that feeling is acknowledged, guilt will always be a distraction, a smoke screen we secretly (unconsciously?) cultivate, effectively keeping at bay the life worth living.

The Care of Aging Parents: Making the Last Laps Rich (Part II)

In Part I on this topic, I centered the post around the idea of setting an intention of what we want in the healing and transformation of the relationship with one's aging loved one.  Opening to the feeling aspect of what it is we want prepares the ground for the details, and helps sees us through the challenges of what is put into play—what, hopefully, we and our parents want.  In this Part II, I will deal more with the nuts-and-bolts of how to provide the sustenance that makes these last laps rich and meaningful for you and them.

Once the intention is set, it is good to determine how you and your elder are going to work together.  Are they handing everything over to you, abdicating all control?  Or do they want to be co-determiners as long as possible?  How will this work, how is it imagined?  Part of the healing in the relationship is the sublime relating we do with them, and they with us.  The confronting the hard things in a soft way, the 'yes' and the 'no's. The disagreements, fears, the sensitivity to the taking control and having little say.  It's this territory that is fertile, if not a challenge to navigate.  This is where we attempt to optimize our Listening,  our Attending-to/Attention, our Observing.  This is where breath and a nuanced appreciation for what Is can transform the difficult transitions.

You see your elder aging, having a more difficult time doing basic things, like laundry, cooking and cleaning.  You might even notice a hygiene deficit or important memory lapses (not taking medications in a timely manner, forgetting to pay bills, etc.)  By this time, it's late in the game.  It's late in the game, because of Denial.  Denial on everyone's part.  Experiencing or noticing a decline in a loved one or self is not easily accepted and often minimized.  We want the old homeostasis, even though change is well underway.  We think it's ok for them to be left alone for a few hours, or even though their balance is somewhat shaky, it's ok as long as their cane is nearby.  This lack of acknowledgement of a decline is denial and it is dangerous.  The primary concern we should have is safety.  Are they safe 100% of the day?  They aren't if they're forgetting medications, leaving the kettle on when on the stove or not being hygienic.  Always best to err on safety's side.  Have more coverage, not less.

Decline comes in all gradations;  gradual to quick.  It's important that once it is underway, there are watchful others around regularly to gage needed interventions.  It might start with grocery runs, housekeeping every other week, or help with a weekly shower.  A decline in social engagement outside the home is a subtle marker as well.  This often happens when an elder realizes they are losing memory (uncomfortable conversing with people who know them but whom they don't remember knowing) or have lost a physical fitness that makes it uncomfortable to be more active.  Losing memory can be very subtle and effectively hidden  by vague responses.  Dementia is masked by depression and sometimes vice versa.  He/she that has created an intention to be the 'observer' engaged with the elder becomes responsible for this watching and deciding/co-deciding with the elder when intervention is required.

Every situation is so different. There are myriad ways people can creatively care for loved ones, and also myriad situations in which the caring transpires.  It may be a collective of family members, or a trusted caretaker or group of them who reports to an adult child who is far away.  Determining the elder's wishes (early on, if possible) is helpful in determining what can be set up (home care, elder care in a senior community, etc).  And of course what is physically and financially possible for the adult child.

Early on, it is vital to consider obtaining power of attorney and/or a medical healthcare proxy for your parent.  It is easier for you to manage your parent's finances this way, and there isn't any holdup when it comes to healthcare decisions.  Outside sources that may be of help are your elder's doctor's office (might have referrals to home care agencies, social workers, etc), and local community senior centers which have programs during the day. Also seek information about alternative resources to support your loved one's needs, be they day/night companions, meals on wheels, rides to doctor appointments, groceries, etc.  If your elder is coming from a hospital situation, case managers and hospital social workers are knowledgeable goldmines regarding external resources and medicare/medicaid insurance payment of needed medical supplies; mine them fully.  Visiting Nurse organizations will do a full home assessment to determine level of care required and make suggestions.  Often, Medicare/Medicaid and private insurances pay most of this service.

When deciding on an elder institution (if that is an option you are considering), ask a lot of questions, field them not only to the 'home', but other professionals.  Hospital nurses that deal with the geriatric population often have an interesting perspective.  They see people come in from different places in different conditions, they hear and are aware of the best and worst places.  From institutions, ask for family references.  What are the activities (i.e.,  are residents ever taken off campus?), is there music, art, plant, pet therapies? What is the ratio of care, caregiver to resident?  Is there a "care for the caretaker" program helping with staff burnout? You should be able to get a rating on the establishment from the better business bureau, possibly AARP, etc.  Once an institution is decided upon, it behooves you to form congenial, informed relationships with the staff; they see you frequently, they know your expectations, they are aware of your strong advocacy for your parent.  When things go awry, a steady, calm, rational response is much more powerful than a reaction.   The former elicits respect from staff.  The latter elicits defensiveness and does not bode well for the care of your parent.  This being said, uncharacteristic strong reactions infrequently provided (and merited), are a heads up, pull-up-your-socks reminder to caretakers, which can go a long way to improving care.

For all caretakers, at any level of care, at any point in time, it should be assumed burn-out, compassion fatigue, will develop.  It is a huge undertaking having the welfare of another in your hands.  Being connected to one's breath, finding nourishing quiet moments for oneself helps to soften the hardness, opens one to another type of rest and rejuvenation.  Take care of yourself; make sure those caring for your loved one are also taking care of themselves.  It is through this regular practice where the quandaries, obstacles and difficulties are often relinquished.  Less tension in your body and in your life allow for another understanding, a possible spark of creative genius in solving a problem, an attraction to the thing or person that is needed in a moment.  This is the miracle of this process.  The process of healing a relationship, transforming a life in the middle and at the end.  This is what makes the last laps so rich, even while it is so hard.

Preparing for Surgery

Surgery is on your (or loved one) horizon.  How to prepare?

Because we are complex, whole people, this is a layered question.  There is the practical outer aspects of preparing and there is the internal aspect (in my mind, also practical).  Whereas every surgery is unique and every person approaching it is unique, there are some universal commonalities.

Anxiety.  Everyone has some degree of anxiety.  Anxiety is promoted by tension, which usually turns to fear which unfolds into streams of negativity.  Finding ways to manage one's anxiety and negativity/fear is key.  Manage is the operating word, because it is only human to have intrepidation moving into the unknown of what will be.  Practically, information gather with gusto.  Find out everything you can about your condition, the nuts and bolts of your surgery including expected anesthesia, the rehabilitation anticipated and the process.  Because of the ACA (Affordable Care Act), it is mandatory for doctors, hospitals and their staff to fully educate their patients on their medical conditions.  There are negative consequences for MDs that don't do this, that don't follow up, or monitor their patient's aftermath from hospitalization (they won't get paid for re-admissions and are accountable to some extent for hospital acquired infections).  Be pro-active, be interested, curious and knowledgeable.  Knowledge is power.  A knowledgeable patient is empowered and that puts you in a strong place entering a vulnerable situation.  With your best inquiring self in place, ask a lot of questions. Keep asking them until you are fully satisfied.  Ignore the huffy healthcare person that is rebuffed or contemptuous of these questions.  Questions help build relationship with healthcare people.  It does not empower or become you to be passive.  If this is difficult for you not to do, good.  It's a challenge to your personal status quo, one you should have challenged a long time ago.  Still, it would be helpful to have an advocate (loved one, family, friend, wellness coach) to saddle up to you through this fact finding mission.  Keep a journal or log of doctor visits, information gathered, thoughts, feelings, experiences with healthcare people.  Practitioners that are deleterious, note and figure how to remedy.  A certain nurse you sense is disinterested, cuts you off, is impatient?  Get another one.  You can ask for this and you can say why.  You want to situate yourself in the best possible position mentally and physically as you can.  So write everything down, chronicle your journey (the good and the bad) and make sure you feel strongly you are in the best  possible place in yourself and in the best of hands walking into your surgery.  Trusting you are optimally positioned before this event means a much better outcome for you.  Having a lack of trust or relationship with your healthcare providers undermines you deeply and this effects your outcomes and healing.

In this anticipatory process the anxiety will get in the way.  You will keep grasping at providers for handholding, your fears will trip you up.  Whereas, its great to gather information, it will not totally alleviate your anxiety.  You must start taking some steps to support your well being.  If  you don't meditate, figuring out what this is for yourself, giving yourself some alone, quiet time every day where there is stillness and breath.  Read up on affirmations.  There are tons of books out there that lead us into a more positive frame of mind through affirmations.  Some are "hokeyer" than others.  You can only skim through potential titles and content to get a feel of what is right for you.  With practice, you start making your own, framing them in your own lingo that feels best for you.  Start some rituals you do everyday.  Five minutes of creative time every day:  write a poem, keep a small book of sketches or quick water colors. A night time ritual of putting yourself to bed; bathing, lotioning, use essential oils, brush your hair, set the "stage" of your bed:  fresh flowers, a candle, meditation tapes.  These are ways we love ourselves, care for ourselves.  Self touch with intention is healing.  You want to kick in the parasympathetic nervous system, the relaxation response, regularly and potently.  The body's cellular memory remembers this and when given the chance goes there more and more easily with these ritual reminders.  Breathe.  Smell the roses.  Smell the coffee.  Take a lot of time to be with yourself and your pleasures. If you don't want to depend on loved ones and you have the resources, hire a wellness coach.  They can give you specific, useful exercises to ground you in quiet and wellness.  After they get to know you, they tailor everything to you, so you will receive optimal, useful information on the pragmatic details as well as the non.  They are your hand holders, the go-to people when a melt down is imminent.  Hired for a specific time period before through after surgery, it is money well spent.

If you are not a pragmatic person, you probably love someone who is.  Enlist this person as an advocate.  Weeks before, have them sit down with you and figure out a strategy and plan for the practical details leading up to the surgery, rehabilitation and beyond.  If you are pragmatic, you probably love someone who is as well (there are a lot of us around!).  Two heads are better than one.  Figure it out together.  How are you getting to (and returning from) the hospital, is your set up at home adequate for your return (do you need a hospital bed, bed-side commode, grab bars for shower, etc)? Schedule helpful visitors for the first two weeks, people who make meals and don't mind doing a little light housework, errands, grocery shop, etc.  Schedule upbeat, easy-going, happy-go-lucky folks; people who have a good comedy DVD collection, who aren't going to do your spirit ill.  Schedule people who know when to stay and when to leave and whom you don't have to entertain (or necessarily entertain you).  Not feeling well is a good excuse to start saying "No" to everything that doesn't feel right.  People who love you won't take offense and will probably learn to be a little more sensitive in their approach.  The best of these folk will help you find the humor in all the "no-s" and be able to bring some lightness to the cranky periods.

These are practical preparations.  The mental and emotional preparation are often the most challenging and also the most important.  When this is well done, the practical becomes a piece of cake, as you are thinking and feeling with more clarity.  Fear isn't the modus operandi.  Also, in being more clear, a plan B often naturally surfaces, always a good thing.  We plan for the worst, hope for the best....  The better your frame of mind and spirit are, the quicker you will rebound, recover.  This is science.  Find your joie de vivre, your life force, your wish to live and prosper and bring them to the event.  Those who are rarin' to go do their physical therapy first thing in the morning post surgery, are positive.  This positivity saturates their being and wellness is theirs.  Their recovery times will be faster, their pain will be less, their outcomes optimal.  They have their endocrine system working for them and their good energy only supports the healing process (unlike the negative which absolutely undermines it).

An upbeat attitude, a good relationship  to and use of your breath and certain essential oils go far in dealing with pain.  Laying a strategy for yourself in dealing with it is important.  In the first few days, take the pain meds allowed.  Trying to be a hero by not taking them can set you back.  In pain, the relaxation response is impossible.  You want those feel good hormones cascading to support your healing process.  You will have good days and you will have bad ones.  Just keep moving through them as best you can, ask for the help you deserve.  All will be well.