Help Has Several Faces

94

Throughout my life I’ve been involved in helping and being helped. In earlier times I tended to take help more for granted. As a child I received help, some I wanted, some I didn’t. As a nursing student and RN I learned to offer purposeful specific health related types of help. It was what nurses did. As a teacher I learned ways to help my students. In familial and social relationships, I learned other approaches. From all of them I learned about the give and take of different helping relationships, somewhat as a matter of course.

Then came the time and experience of aging where my prevailing situation has become more often that of being the one in need of help, with only limited capacities and resources for helping others or even reciprocating to those who help me. Engaging with this helping element of aging led me to start looking at the basics of this helping business.

I began to see helping as consisting of three options: doing to, doing for and doing with. I looked for examples of each in my daily and found them.

I thought of those whose help involved doing to me.

I consult and use professionals to manage my physical health, e.g. the dentist, dental hygienist and physician who diagnose and prescribe and at times do to me, the pedicurist who keeps my (now distant) toes and feet in shape. Since I take the initiative in consulting them and the extent to which I follow up on their proposals, I still have some options. But I can readily foresee situations and institutionalizations in which the doing to will be increasingly extensive and out of my control.

The next “doing to” is less obvious. These examples involve those who knowingly or unknowingly communicate words and behavior that “do to” my mental and emotional status for good or ill.   But thus far, I sense that I do have some choices in how I use that input. (See Data are Neutral, My Reactions are Not 4/24/19, and Words Make a Difference 5/29/19)

Real, but even harder to detect, is the doing to by known and unknown people, businesses and institutions whose way of functioning or business model includes sharing information about me or purposefully invading my privacy with or without privacy forms (whose language is often so arcane and obfuscating that it’s hard to know what one is signing). They do to me without my knowledge.

I see doing for me as involving help that takes the place of what I would/might wish to do for myself.

Usually it occurs after learning what I need or want, but occasionally is based on what the helper thinks might be best for me. Sometimes it has been helping me to look at situations through “fresh eyes”.   And then there are people doing for me in ways that go beyond what I might have wished for, or even thought possible. And such thoughtfulness is as much a gift as the gift itself.

Finally, there is doing with.

This involves mutual engagement.   Here each of us has a sense of gains in the helping activity. The result feels greater than the “sum of the parts”. I’ll have to admit this is the most satisfying kind of helping I experience as helper or helped.

I find that each type of helping has its place.   Being an EWA-ing help recipient demands that I:

seek help appropriately in terms of when each type is most useful and desired

recognize the type of help that is being afford and respond accordingly

provide helpers with data and information to enable them offer help in ways that are most effective, efficient and satisfying to us both.

Advertisements

Aging is More than Health

Healthy:   possessing or enjoying good health, a sound and vigorous mind and body; freedom from disease or ailment

Health: a perspective for judging the status of mind and body, or the merits of a presenting situation in terms of being conducive to a sound body and vigorous mind

The way non-aged people view aging and the aged tends to be linked to their background and particular interests. Individuals, relatives, groups, disciplines, professions, businesses, legislators, economists and governmental agencies each view aging and the aged through their own mindsets, value systems and purposes.   Many of them include the health of the aged or their environments in their considerations and actions.

As a nurse, I was taught to view aging from birth to death from the perspective of health, normal versus abnormal.

87 1

I looked at my patients and their environments through the lens of health and I worked for its promotion, maintenance, preservation, treatment and palliation. My viewpoint was wide-ranging even as I aimed for specificity with individual patients. But in my mind (rightly or wrongly), health however applied, tended to involve gradients of healthy and unhealthy.

Now, decades into engaging with my own aging, I find that seeing aging solely, or even primarily, through the lens of health is too confining.

87 2

I sense that it can put blinders and dampers on truly significant facets of my aging experience. That bothers me.

87 3

I don’t question that my health is hugely important to the quality of my life and aging, nor that my behavior and activities are strong influences on my health. I know that my health determines what I can engage with and how I am able to engage.   It’s just that I’m discovering that aging is so much more than health.   For example, nutrition, hydration and exercise are seen as three pillars of healthy aging. Yet the experiences of eating drinking and moving about each day encompass so much more than the health promoting considerations.   I experience the sensory elements, the tastes, textures, aromas.   I recall wonderful associated memories of food-related occasions, both ordinary and grand. The same holds true with movement related experiences. Thinking about the richness of these memories it makes me want to anticipate and enjoy them in present and future activities without having to look at them through the lens of health during the experience.

My aging is filled with intangibles of life and living, with all its richness, its flaws, its details, its marvelous surprises and unexpected pitfalls.   It’s the contemplation of life and death. The experiences of blessed solitude and the warmth of companionship with people who have such wide interests and fresh ideas or different experiences of the past. It’s the seasons and weather in all their dimensions. It’s art and music, comedy and drama.   It’s my vistas of mountains and water; the busy daytime city and the quiet, amber of its nighttime. It’s the ballet and battles of hummingbirds at the feeder and the busyness of mason bees going in and out of their homes outside my kitchen window. It’s the movement in tall evergreens in the invisible winds and their windless stillness. It’s the comfort of a cat on my lap and the warmth of hugs. The aroma of the first cup of coffee and the uncertainty of completing the morning crossword puzzle.   It’s the joy in feeling fulfilled. It’s the mourning with losses. It’s being both needy and yet capable of helping others. It’s knowing and still learning. It’s . . . . . . . . . . . . . . .

I don’t want to feel hemmed in by obligatory calculations of their effect on my health in the midst of these experiences.   I want to freely, profoundly experience all these and more, unalloyed and unexamined.

87 4

I’m not foolish. I want to retain and use my health lens appropriately and creatively. I want and need to securely keep and use it . . . . in its proper place.

 

Data About Me Are Neutral But I’m Not Neutral About Them

78 1

As a nurse, I learned about health-related data. I learned how to collect them appropriately and correctly, how to report them in usable form and how to use them to guide my nursing care. Often they were numbers ( temperatures, pulses, respirations, blood values), reports of surgical procedures and tissue findings. They also involved patients’ and families’ responses to the situations they were facing. I cared about their being accurate. The data themselves were neutral, neither good nor bad, just what they were and what they represented. The diagnoses and other judgments resulting from the data were also neutral to the scrutinizers and decision makers. But for the person generating the data, they all carried emotional weight that was anything but neutral. Data could elate! Data could depress! Data could frighten!

Now as I face daily the reality of my aging and the environment within which it is taking place, once again I am purposefully gathering data. But now I have to remind myself (sometimes forcefully), that indeed the data are still neutral and separate from my reaction to them. It is what it is. I need to keep in mind that my reaction is itself data that I need to use neutrally in order to engage with aging in the most effective way. I am what I am — no more, no less.

A sampling of frequent data these days includes:

I drop things, often. Reaction: frustration !!!!!

A sense of “near-fall” when I bend over to do things or turn without thinking. Reaction: my stomach “drops” and I experience everything but the fall itself. Near-falls leave me shaken and frightened (though massively relieved and grateful that the fall did not occur).

There are numbers on my scale. Reaction: Happy when they are the same or a bit less than yesterday. Reaction: Resolve to eat prudently when they are higher.

More hunger after a meal that should have been satisfying than I had before I started. Reaction: “That’s unfair.” Sometimes I resist giving in and eating more/sometimes I eat more; sometimes I deliberately get busy and distract myself till the hunger passes.

Signals of fatigue before tasks are completed. Reaction: resistance + dissatisfaction. Occasionally leaving task unfinished for the time being.

Recuperative periods characterized by an almost vegetative state when I’ve purposefully or unavoidably exceeded my limits. Reaction: impatience or “It was worth it” or both.

My balance is becoming noticeably tippier, as is my ability to rise from sitting to standing. Reaction:   Concern about how much longer I will be able to manage safely in my highly prized independent lifestyle.

In my intake visit the doctor pronounced me “healthy” and the blood work numbers a week later verified it. Reaction: walking on air. Relieved — “So far, so good.”

Careful comments from my family identifying blind spots or concerns. Reaction: wish they hadn’t been necessary. Sometimes guilt because I should have known better. Always gratitude that they are willing to do it and are so careful about how they do it.

Much as I believe in it, my seeing data as “neutral” is not automatic. I know that data are tools to be used for adaptation and I do use them that way.   But even with these beliefs and experience, seeing data as neutral is still a conscious decision that I have to make almost every time.

78 2

Daily Living with Aging Involves More than Health

Human aging: progressive accumulation over time of physiological, psychological and social changes.

           Health:   the general condition of the body or mind with reference to soundness and vigor, freedom from disease or ailment.

 Aging is a many-sided status that can be seen from different angles depending on the background and interest of the beholder.  Aged or not-yet-old-relatives, groups, disciplines, professions, businesses, legislators, economists and governmental agencies each view aging and the aged through their own mindsets, value systems and vested interests.   Many of them include the health of the aged in their focus and actions.

As a nurse, I was taught to view aging from birth to death from the perspective of health. Normal versus abnormal.   I looked at my patients through this lens of health and I worked for its promotion, maintenance, preservation, treatment and palliation. My health-oriented viewpoint was wide-ranging even as I aimed for specificity. But in my mind health tended to involve gradients of healthy and unhealthy.

73 1

Now, decades into my “old age”, I find that seeing aging primarily through the lens of health is too confining. I sense that such a viewpoint can put both blinders and dampers on me in ways that influence aspects of my aging experience that may be only marginally associated with health.

73 2

I don’t question that health has huge importance to my life and its quality. It determines what I engage with and how I am able to engage.   Perhaps it is because I am remarkably healthy that I’m finding the aging experience to be so much more than health.   (Those of you with ongoing health problems can let me know if this is true.)

My aging experience has been full of intangibles, filled with both richness and flaws. It’s held remarkable surprises and unexpected pitfalls. It’s offered defeats in efforts to manage growing incompetence, and prevent accidents or illness, and bursts of triumph when I outwit them.   It’s the impatience with functioning at my ever-slowing pace. It’s the feelings of loss in areas of control and privacy. It’s the mourning with losses, even little ones.   It’s the contemplation of life and death.

My aging has offered a wide range of new experiences.   A sense of time and solitude, to allow just being, reminiscing and hatching new ideas. The warm closeness of companionship with visitors, emailers and characters in good books.   The changing seasons in all their dimensions of growing, maturating and resting.   The music that brings memories of performance or listening. Vistas of cloud formations, sunrises and sunsets over mountains and water; the busy daytime city and the quiet amber of its nighttime. Ballets and battles of the of hummingbirds at the feeder outside my kitchen window. The movement of tall evergreens in the invisible winds and their windless stillness. The comfort of a purring cat on my lap. The warmth, color and movement of flames in the fireplace that holds darkness, cold and loneliness at bay.   The aroma of the first cup of coffee and the uncertainty of completing the morning crossword puzzle.   My joy in feeling fulfilled in tasks I didn’t think I could do. My feeling both needy and yet capable of helping others. My knowing and still learning. The years of aging have brought all these and so much more.

I want to freely, profoundly experience all of the facets of aging that come my way. I want to do it untrammeled by any need to consider whether something I’m experiencing is healthy or unhealthy. But at the same time I want to retain and use my health lens and knowledge . . . appropriately and creatively.

73 3

I want and need to keep my rich aging experiences and my health, each in its proper place and help those who are a part of my aging experience to do this as well.

When Initiative Does a Disappearing Act

69-1

Somehow, somewhere, I began to realize that my “get up and go, got up and went,” quietly, sneakily over time. I suppose that is better than having it drop off suddenly because of an accident or illness. But still, I miss it. Of course there always have been less desirable tasks I’ve had to force myself to do and others I could do all day long. But these days, even things that don’t require much physical energy and that I don’t mind doing have become a chore. I postpone, make excuses to myself or decide they aren’t all that essential. Now this is something new.

  • Data: Almost everything feels like “too much.” How can that happen when I’m still basically happy and healthy? I still can do and actually accomplish the avoided task (in one way or another), when I actually get started.   So it’s the “getting started” that has changed.   I feel guilty when I loll about not doing what I know needs to be done, so it’s no pleasure. And certainly I’m relieved, satisfied when I do them.   My daily living balance of requirements and resources is out of balance in a way that feels important and I’m not happy.

Given this data base, it’s time to put my EWA to work and see what, if anything, I can do about it.

69-2

  • My first EWA task is to consider my indolence’s dynamics and genesis.
    • The thought that comes to mind is that: not-doing-something involves decision making as much as doing something does.
    • I remembered that both short term memory (STM) and decision making (DM) parts of the brain start decreasing their efficiency in the fourth decade.
  • Then compare that undergirding knowledge with my presenting situation.
    • Yikes, mine have been on a down-hill journey for close to 50 years and will no doubt continue. It’s just progressed from having difficulty deciding; what to wear, what to pack, what to eat, etc. to whether or not to do a single task and just not doing things, or at least putting them off, making excuses to myself.
  • Next, it’s time to get creative. I considered whether any strategies I’ve been using successfully with some lapses in STM might apply to this.   (Why reinvent the wheel when it might be usable in a different way.)
    • Developing rituals successfully counteracted the way STM (1/21/17) was messing up my life. I found it challenging to stick to the rituals in the beginning, but now months later they are almost habits, habits + conscious mindfulness actually. I feel positive and more in-control when I do them.

This strategy might be a way to work around my waning decision making. (see 2/22/18; 12/12/18; 1/15/19)

  • My initial adaptive strategy: Develop new rituals of making a commitment to: complete every cluster of related activities at the time I engage the initial one (rather than move on to something I’d rather do).
  • E.g. I’ll dress when I get up and make up the bed, hang up or dispose of any unused clothing before leaving the bedroom. I’ll rinse and stow the dishes in the dishwasher after each use. I’ll prep the veggies and start the soup base after I stow the other purchases etc.  

Well that’s a start. I’ll see how that goes.   With any success and feel-good from those efforts, I suspect my brain will alert me to other tasks I can take on and handle differently.

  • Progress report and evaluation A couple of weeks into trying the above and adding other areas to it seems to be working.
  • I’m holding to my commitment of clustering related activities and it doesn’t feel too demanding (much to my surprise)
  • My brain seems to be enjoying a new challenge and appears to still be wired to remember, manage and even add new areas.
  • I’m feeling gratitude that other parts of my brain seem to be allowing me this much recognition of changes and creativity to make working adaptive strategies.

I do hope it all holds out for some time. But that’s the concern for another day. “Sufficient unto the day …” still needs to be my motto.

Have any of you readers had this challenge?
How have you managed?
Please share.

Me, Elderly Yes! But an Elder?

“Our elderly are seldom elders.
When they are true elders, we fall in love with them.”
“Falling Upwards: A Spirituality for the Two Halves of Life.” Richard Rohr, 2011

Someone who commented on a recent blog post identified me as an elder and offered the above Richard Rohr words. She had been a student in one of the first classes I taught at the university and had stayed in touch over the intervening decades. So she was someone I knew, who also knew me. I’d never had this label given to me before and I don’t quite know what to make of it. But if I’m being identified as an elder, it seemed to me that I at least ought to know what an elder was or perhaps ought to be. I had a vague sense of what an elder-type of person was. And I certainly had been blessed with some of my own who enabled me to grow in ways I hadn’t envisioned. But thinking that I might be seen as one is a whole different matter.

Time to find out what attributes an elder is thought to possess. Below is a summary of the traits and behaviors I found that others associate with persons identified as elders. They:

are not born or appointed, but emerge as the sum of their experiences of life

tend to have a quality of simplicity, humbleness

know traditions, live by them, can apply tradition in nontraditional ways;

have lived through difficult times and are still standing , learned from them, remain hopeful

search for meaning in life and events

are practical/ have practical situations to attend to

don’t take sides, criticize,

tend to be non-judgmental

offer availability, time, patience

exert influence directly or subtly, sometimes by just being in their presence (a process of osmosis?)

tend to influence feelings, attitudes, behavior, perspective.

List in hand I began to take stock of myself. In my 97 years, I had personally experienced difficult situations: the shock and prolonged deprivations of “The Great Depression; the fears and realities of total personal and national involvement in lows and highs of World War II, nursing in the time before the availability of antibiotics, antipsychotics, and technical monitoring devices. I’d nursed when my city had the highest incidence of tuberculosis in the United States (there were institutional beds for only 30% of the cases and there were no curative drugs). I’d cared for children during the polio epidemic with sister Kenny hot packs and iron lungs before Salk vaccine became available. I find that I did learn from each of them and that they affect my values and behavior. I’ve experienced the death of loved ones, parents, sister, husband. I know I enjoy simplicity and practicality. Aging has given me everyday practicalities to tend to.   I do search for meaning. I’m mixed bag in terms of being judgmental, but I’ve become much less so as I’ve aged; now I tend to search for meaning. Certainly these days I have time and availability.

Now as to the remaining characteristics. While they feel comfortable to me, I have no sense that I’m gifted in any of them. I’m very happy with the relationships I have with others these days. So I’ll keep “elder” characteristics in mind and muddle along.

How about you?  Have you been blessed by having elders in your life? Do you fit the pattern? Can you see yourself in the role? Have you been given this label? How did it feel to you? Should we who are old feel some responsibility to serve as “elders” to those close to us?

67

Doesn’t? Can’t? Won’t? Is the difference important?

66

Doesn’t: is not observed or known to engage in an activity or behavior

Can’t : is unable to or prevented from engaging in the activity or behavior

Won’t: actively refuses or avoids engaging in the activity or behavior

When I was a young, naïve nursing student (and who knows how long afterwards), I think I assumed that the health care system “knew best”. My focus and goals were to enable those I cared for to take part in prescribed activities.

I remember situations of my own and those I’d hear about in change-of-shift report where patients were labeled as being “non-compliant” in one way or another. We nurses had often explained the purpose and reason for what was expected of them, supported them in doing them.   So why didn’t they do it? Were we to blame for not having taught, demonstrated, explained, supported well enough? Were they just being lazy, stubborn or willful? I heard all sorts of reasons in the blame game.

Later I came to wonder why it hadn’t occurred to me to explore how the proposed activity or behavior appeared to patients and their families. Were they afraid to try? Did it conflict with views or values they held?   Were there higher priorities? Constraints coming from others? from the environment? from economics? or?   Was there something I could do to make it easier, more understandable, alter the timing, or ?????? Were there alternatives that might seem more acceptable or possible? Or? Or? Or? But I didn’t even think of those things, much less act on them.

Now, as an aged person living almost-independently, I experience the occasional suggestion or recommendation from my near and dear ones.   I feel so fortunate that they keep a watchful eye on me, but never intrusively. Their rare “suggestions” are carefully proposed and seem reasonable. Their, “Be careful,” “Keep your phone at your side,” “Don’t worry about . . .” are behaviors I totally agree with. I want to carry them out consistently. But, distraction, lapses in short term memory or “just can’t be bothered this time”, intervene and so my compliance is spotty. With some of their ideas I may delay acting on them. If I wasn’t going to agree to something, I’d explain my rationale. We could agree to differ.

But I have my own shoulds and “don’ts”. Thanks to my clinical practice, teaching and writing background in nursing, I pretty much know what I “should” do in the face of my aging. Occasionally, a few of my age-related-changes are causes for “can’t”, e.g. foot care for feet I can no longer reach and, getting in enough protein when meat tastes like cardboard. I haven’t yet come across any situations that really require action that I “won’t” take. But daily I struggle with a lot of shoulds that I just “don’t” do.

When I was growing up, we drank water when we got thirsty. Nobody talked about hydration!   So habit wins out over should and I often fail to hydrate myself to the current suggested standard.

I know I should get up and walk around the house every 20 minutes, but I become engrossed in my writing or a book I’m reading and it may be an hour or two before I get up and purposefully walk or do tasks that require standing and walking.

So, do I still think it’s important for agers to look at ourselves, identify what we don’t, can’t or won’t? I do. And I also think that it’s important to be able to explain it to care providers as they prescribe treatments that will create difficulties, or others who have ideas about what is “best” for us.