Sarah Neeley

Have you ever felt that your underwear was showing or that you had lipstick on your teeth and no one told you? If your grief is showing, everyone will tell you.

I am so blessed by the love I have been shown during this very initial grief process, but I am also amazed at the angst and disharmony my grief causes others. So, in a true attempt at education, I ask that we all not ask the grieving the following questions nor make these statements because they may get a real response.

1. “How are you?” This is meant as kindness. I want to say, “My whole world has fallen apart and I can’t think or breathe.”

2. “You look thin.” I cannot swallow because my throat is too tired from crying. Food and other worldly appetites are far very far away.

3. “You look tired.” This just does not ever need to be said to anyone.

4. “What can I do?” I have actually asked people to make my husband undead. This seems reasonable because they asked and I know they would do what they could. Please say instead what you will do, and do. Drop by, have lunch or just listen.

5. “You are young…” I think this means that I will grieve and find another. Soul mates are not akin to replacement parts for my former 1985 Volvo. I have no clue what my future will embrace and I do not care right now.

6. “You are doing great.” Because I have not cried in your presence for a week means nothing. My tears are present and are not an indication of how poorly I am coping but of how well I am coping. My husband was proud that I finally began crying. I have not stopped. Perhaps tears are merely angels’ whispers.

7. “You are a hospice nurse, so you know everything about grief.” I am very adept with death and dying, but grief is a separate issue. Death & dying and grief & bereavement are akin to thinking hot dogs go with crème brûlée.

Grief is one surreal moment after one sacred event. I am convinced that people are good and that people have good intentions. I am blessed to have to have been taught so many great lessons by the man I grieve.

Sarah Neeley has been part of the Alive Hospice Team for 26 years. She joined the agency as a home-care nurse in 1983 and today serves as clinical nurse educator.

• After a loss, sometimes “just” a hug is what’s needed
• The other side: Giving, then receiving, the blessings of hospice care 

Volunteer Nan Shinn with Mr. Morgan Davis and Baldwin the cat on a Tuesday visit at Alive Hospice Residence Nashville.

 Mr. Morgan Davis reached out his hand to stroke the furry, four-legged visitor that had come to see him.

“Hi, kitty,” he said as he patted the placid creature, a cat named Baldwin.

A short-haired black cat known for his gentle bedside manner, Baldwin is one of several pet therapy animals that visits patients and families at Alive Hospice Residence Nashville. He has been making weekly rounds there with volunteer Nan Shinn for the last six years. It’s hard to count just how many people they have called on in that time, but all told, they’ve logged more than 2,000 hours together.

It warms the heart to see the reactions Nan and Baldwin get when they drop by. Staff members grin at the sight of the golden-eyed critter, and they can’t help reaching out to pet him. Inside patients’ rooms, the reactions he gets are even sweeter.

“Come in, come in, come in!” many have said. “I didn’t know there were cats here!”

Click here to read the rest of the story in the Fall 2009 edition of Alive Hospice’s Connection newsletter. (The story is on page 5.) 

ONLINE EXTRA: How did Baldwin get his name?

From Nan Shinn: “My husband found him on a Baldwin trail in Florida. They turned old railroad lines into bike and walking trails. My husband was 6 miles out on this Baldwin trail. He said, ‘I saw up ahead a black blob.’ As he got closer, (a cat’s) little head popped up and he started to run after him. When he turned around and saw this kitten, what could he do? He wasn’t even a pound. He was very sick.

“He gets back to the car and calls me, and I hear, ‘Mew, mew, mew!’ I go, ‘Oh, no!’ He goes, ‘Oh, yes!’

“We just thought he was this outgoing and great kitten. He’s doing great. He’s healthy. He’s 8 years old. He’s a good guy.”

Dr. David Tribble

Several years ago, I sat with a patient of mine and his adult daughter in an appointment for review of his goals of care. Tests had revealed that he had pancreatic cancer which was already far advanced, as it can sometimes be at the time of discovery, and his consultation with oncology had led him to conclude that oncotherapy (chemotherapy, radiation therapy, surgery – any disease-remittive therapy) offered him more burdens than benefits.

In the end, I listened more than I talked and had only two offerings.

•  For his daughter: “He is going to want to talk about how his death will be and what happens to his stuff. You need to let him.”
•  For him: “This is the last opportunity for her to give to you the best that she has. You need to let her do that.”

Now, having read Sarah Neeley’s blog, I am impressed with just how much that advice demands, particularly of we who have committed to be the pillars on which others lean. We will all, as Sarah has, reach a point where it is time to allow others to be for us what we are for others so willingly. We will have to trust that our needs are no more an imposition on them than someone else’s were on us. 

We will have to yield control and let someone else be our strength. Our caring for others turns out to be training for our own lives, if we will let it, and in the end, we get as much as we give if we let our patients teach us.

Dr. David Tribble is Alive Hospice’s chief medical officer.

Teresa Yarbrough

“Welcome.” One rendering of that term expresses it more fully as “May you have fared well in coming here!”

That broader phrasing of the expression of welcome seems to be most applicable for what we, as staff at Alive Hospice Residence Nashville, deeply desire to offer patients and their families as they arrive for their stay with us. New and unfamiliar places and experiences can be unnerving and uncomfortable in the best of circumstances. Needless to say, a change of a home address to 1710 Patterson Street in Nashville, TN (Alive Hospice Residence Nashville) would be classified by very few as a preferred life change. Anxiety, fear, anger, and depression are common emotional responses to the need to be cared for in a hospice setting. And the emotional components of the state of transition that patients and their families find themselves in are only part of the big picture. Confidence in the proper and effective management of any physical symptoms burdens the patient may be having is a huge priority for the new arrivals to our care.

Flowers are just one of the ways the staff at Alive     Hospice Residence Nashville says “Welcome,” even     before patients and families walk through the door!

A warm handshake and sincere smile, a timely response to possible discomfort or difficulty with breathing for a patient, an offer of cold ice water, fresh hot coffee or cocoa, an invitation with interest to hear the story that brought them through our doors, a walk to one of the family rooms, a trip to the fish pond in the courtyard, a tour of the beautiful artwork throughout our building — any or all of these are only different means to the desired end of helping our patients and families feel welcomed in what may very well become their new home for this season of life.

We hope that, in time, we will earn their trust and confidence and that we prove ourselves worthy of those honorable gifts. We want to express our welcome in a tangible way that says, “May you have fared well in coming here!”

Teresa Yarbrough is a registered nurse at Alive Hospice Residence Nashville.

Ruth Williams

I may be a grief counselor with Alive Hospice, but like everyone, knowing what to say when a friend loses a loved one is not always easy.

I recently lost my mother. I inwardly smiled when I heard some of the typical comments, like: “Well, it must have been her time.” “She had a good long life.” And, “At least she’s not suffering any longer.” I smiled because, as grief counselors, we often talk about those clichés as being difficult to hear at times. Fortunately, I was able to smile quietly and accept these comments as well-intentioned.

When you lose someone you love dearly, often there truly are no words to heal the hurt or even soften the pain that is very real, regardless of the relationship, the age, or the circumstances of the death. If you are with someone and fumble with what to say, sometimes a hug or a squeeze of a hand is as helpful as anything. I am also surprised by how touched I was by the cards that I received. I got more cards than I ever got for birthdays or even Christmas! And, sometimes, the card companies have beautiful expressions that put into words what our hearts are trying to say. To me, just seeing who signed the card was meaningful.

Listening when the grieving person wants to share may be invaluable. Being supportive in whatever way is authentic in your relationship may also be helpful, whether in an emotional way or more concrete way (i.e., helping with meals, transportation, errands, etc.). And try, if you can, to avoid some of the expressions that are so tempting like, “You’ll get over it, it just takes time.” However well-intended, those comments are often received as attempts to minimize or deny the pain that is very real and very present.

So, sometimes, just being present with the grieving person may speak more clearly and sincerely than words.

Ruth Williams is a counselor with Alive Grief Support Services, the bereavement support program of Alive Hospice.

President Obama will discuss health-care reform tonight, Sept. 9, in a televised joint session of Congress. The address will be carried live on major television networks beginning at 8 p.m. EDT (7 p.m. CDT). It can also be viewed online.

From the White House Blog: “Tonight the President will make clear to Congress exactly what he would like to see in the health insurance reform legislation that gets sent to his desk …. [T]he President will explain how these bills should be pulled together to find the best solutions possible to bring peace of mind to Americans who have insurance and affordable coverage to those who don’t.”

For the history buffs and policy wonks out there: An interesting post about the rarety of presidential addresses in joint sessions of Congress, courtesy of USA Today’s The Oval blog about the Obama presidency.

Nanette Mathe

Working in hospice has changed my daily practice. I have learned from my patients to practice and celebrate what is truly important in life. Each patient finds what is important and embraces it. For example, patients may choose family, friends, music, nature, movies, sports, or hobbies as being important to them (and the list goes on).

My patients choose what is important to them that day and celebrate it. I have learned to celebrate what the day brings, practice what’s important to me, and share God’s love. When I live this way, each day contains a beginning, middle, and end. If I die tonight, there would be no regrets.

Nanette Mathe is an Alive Hospice chaplain.

Dr. David Tribble visits a patient at Alive Hospice    Residence Nashville.

The Tennessean recently published a guest editorial by Alive Hospice Chief Medical Officer (and blogger!) Dr. David Tribble regarding end-of-life care and the health-care reform debate. Dr. Tribble’s editorial, which was part of a package of editorials about this important and timely topic, may be viewed here.

An excerpt: “(End-of-life care) provides quality health care whose results compare favorably to the alternative; is available to all Medicare beneficiaries; preserves choice; and withholds no effective therapies. It is the one part of health-care reform that has a track record of delivering on these promises.”

Links to editorials that share additional views on end-of-life care and the health-care reform debate can be found by accessing Dr. Tribble’s guest editorial. (Look for “Related articles” on the right-hand side of the page).