Tough Conversations

Solutions Through Compassionate Communication.

Winter Love – And Worry

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Dianne Rehm is the recently retired host of NPR’s “All Things Considered,” a talk show from Washington, DC. John Hagedorn is a retired Lutheran minister. The Washington Post dubbed their Washington Cathedral wedding on October 14, 2017 ”a sign of hope.”

The gorgeous, adoring couple exchanged traditional vows surrounded by friends. What drew attention was the ages of the bride and groom. She’s 81, he’s 78. The Rev. Canon Jerry Anderson said they are the oldest couple he has married in 49 years.

The news made me smile. In many respects, their story is my story. Last April I married an old friend, Jim Le Gette. A few months after the wedding, we both turned eighty.

Like Dianne and John, Jim and I knew each other for many years (thirty in their case, fifty in ours). Like them, we’d lost mates after long, happy marriages. Like theirs, our friends were delighted but surprised.

It’s not unusual for older people to get together, even to live together. But it is rare for them to marry. Why? One reason may be more about their children than themselves.

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Transparency Revisited

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Transparency… with Conditions

For years we have advocated greater transparency among family members when addressing issues, such as:
— the location of a parent’s will and other important documents;
— how a parent intends to bequeath her assets;
— whom the parent designates as executor of his will and his powers of attorney;
— the terms of their living will and who will make healthcare decisions for them should they lack capacity to voice their preferences; and where they would reside if they can no longer live independently.

We consistently urge parents to share this information with ALL their adult children. No exceptions. To exclude an adult child risks troubled relations among their children long after they’ve left this life for the next.

Worthy counsel indeed. But let’s remember that transparency is not an end in itself. The goal is family harmony, ensuring adult children understand their parents’ wishes, that they are willing to take the helm if a crisis affects their parents’ well-being, and honoring their wishes should they suffer a life threatening illness.

But what happens if these good intentions go awry? What if an adult child resents that another of his siblings is named financial power of attorney? Or a family member objects to an older adult’s aging in place rather than entering assisted living? Or a sibling takes issue with a parent who opts for hospice care rather than undergo high-risk medical treatment for a chronic illness?

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Parenting: A Life-Long Calling

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We’d like to share an article written by Carolyn, and published in this month’s Redbud Post, which reflects on the life-long nature of parenting.

Parenting: A Life-Long Calling

When my girls were tiny Jerry and I cherished every new miracle. The first baby tooth! Eating finger food! Crawling, walking brought applause and cheers. I loved watching their little minds work as they began to talk and figure out new experiences. (At first sight of Georgia clay, two-year-old Dede sang out, “Look, Mommy! Sunburned dirt!”) We were starved for sleep but filled with awe, wonder, and gratitude.

Their school years flash across my vision in stop-time photography. Trish in her ballet tutu. Kim sprawled on the floor, pen in hand, fingers flying across the paper creating edgy cartoons. Dede shyly offering me her gift of a pair of gargoyles—mugs she designed and created from potter’s clay. They’re on my desk as I write and never fail to evoke a smile.

Read the entire article on the Redbud Post.

 

Planning 10.0: Your Ethical Will

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Besides our will, powers of attorney, trust documents, and other legal, financial, and end-of-life instructions that we should share with family members, we need to prepare one other item: our ethical will.Planning 10.0: Your Ethical Will

Ethical wills (or legacy letters) are designed to transmit values from one generation to the next.  They set out our beliefs, principles, and hopes for those who succeed us.  An ethical will often include what we’re grateful for and our expectations for the future.  They are best written over an extended period.  Their purpose is to express what we hope our children will continue to follow and abide by.

Ethical wills are nothing new.  Their origins are rooted in Biblical soil.  Think of Moses speaking his parting words to the children of Israel as they were about to enter the Holy Land. Or, Jesus’ Sermon on the Mount in which he told his disciples that, among other Beatitudes: “Blessed are the meek for they shall inherit the Earth.” [Read more…]

Entering ‘Elder-dom’

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Why is it so difficult for many of us to engage in tough conversations with our parents or close relatives about their futures? Why is such a discussion with our elders often like entering a moated castle with high walls, armed guards, and nearly impenetrable access to the rulers?

It should be simple, right? We need to talk about their (fill in the space). Driving? Moving to independent living residence? Talking with an attorney about their wills? Need to check out Dad’s diminishing eyesight? Mom’s chronic imbalance?

What’s keeping you from entering the castle of elder-dom? Let’s start with role reversal: Mom and Dad were always the permission givers, advice purveyors, financiers, shelter providers, big picture designers, and decision makers. Now you want to talk with them about their safety, their finances, their care. Imagine how they must feel.

What’s left for older adults in their 80s,’ 90s,’ and even beyond? Loss of independence is all around them: Friends have died. Can’t drive at night, or not at all. Mobility hampered by hip replacement surgery, dementia, and other physical and psychological impairments. Loneliness. Isolation. A changing neighborhood. Unfamiliarity with the technological changes around them.

Many inhabitants of ‘elder-dom’ feel they must clutch onto whatever remnants of independence remain. No wonder entering elder-dom can be so challenging.

What can we do to ease our entry?
1. Listen to comprehend, not to argue. To build confidence, not anxiety.
2. Understand that these conversations are a process, not a one-shot. They may take multiple sessions over days if not weeks.
3. Focus on the issue, not the individual. If it’s your parents’ safety, focus on that, not their attitude, their possible stubbornness, nor their resistance.
4. If the conversation becomes too emotional, stop. Take a break. Change the subject. Don’t let things get out of hand.
5. Make sure you know what you’re talking about. If it’s about moving to an independent or assisted living residence, have you information on its location, cost, amenities, etc?

Entering Elder-dom is so important that we will offer more thoughts about it in the coming weeks.

Meanwhile, keep listening. It’s the most powerful resource you have to breach the walls of resistance and silence.

Sig Cohen

Time to Hang Up the Keys?

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If a discussion about driving between an adult child and his or her parent is difficult, imagine how challenging an older adult’s interior conversation is when deciding whether to continue driving.

Say, you’ve reached the age of 85. Been driving almost 70 years. Maybe been in an accident or two. Only one speeding ticket on your record.

Your last physical pronounced you hale and hardly. But there are warning signs: Getting harder to park? Some scratches and scrapes you’re hiding from the family? Didn’t see a mother and her infant in the crosswalk until almost too late? Getting harder to see at night, or maybe seeing double?

(Difficult as it is to give up driving, more than 600,000 drivers ages 70 or older voluntarily stop driving annually, according to a 2002 study in the American Journal of Public Health).

Aware that ending driving can be a body blow to one’s independence, how can we know when it’s time to hang up the keys?

1. Look at AARP’s ten warning signs that tell you whether to limit or stop driving. They include getting lost in familiar places, having trouble following road signs, and reacting more slowly to unexpected situations.
http://www.aarp.org/home-garden/transportation/info-05-2010/Warning Signs Stopping.
The National Highway Traffic Safety Administration also has a safe driver self-evaluation test. (www.nhtsa.gov/people/injury/olddrive/OlderDriversBook/pages.

2. Take a vision test or any number of AAA or AARP driving evaluations.

3. Try out a virtual driving test websites like Drive Sharp. Drivesharp tests your reflexes in different emergency situations. www.drivesharp.com. Your score may indicate whether your reflexes are quick enough to continue driving.
Finally, remember the differences between an issue, emergency, and a crisis:
An issue is recognizing that your behind-the-wheel skills have declined.

An emergency might be last week’s fender bender or getting stopped by a cop for cruising past a stop sign.

A crisis could be the child you haven’t hit or the pile-up that hasn’t occurred…yet.

Sig

Catching Flies (Otherwise Known as Reframing)

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My mother used to say, “You catch more flies with honey than you do with vinegar.” I thought of Mama when I recently walked into my new doctor’s office for the first time.

We’d met in the hospital after my trip to the ER with scary symptoms that turned out to be a false alarm. This man is laid-back, affable, reassuring, approachable – thoroughly likeable in every way. Let me be clear: I am a fan.

So I was surprised by his office. Signs attached to the waiting room walls bore warnings and prohibitions in capital letters and bold print. They scowled at me like an angry nun with a pointed ruler.

“Do NOT ask us to prescribe anything but [medical specialty] medicine.” (There followed a list of meds that were NOT to be requested.) “NO eating in waiting room. “ “Copays are due SAME DAY of visit.” The only “please” I saw was also a rule: “Please do not touch the TV.” 

Monetary penalties were listed for missed appointments or late cancellations, extra fees for requesting records. All were full of NOs, NOTs, and MUSTs. I felt like a naughty child about to jump on the sofa.

Lots of vinegar!

I mentioned my surprise to the doctor. He smiled (a little sheepishly I thought), “Our lawyers make us do that.” Now, I’m a lawyer. I understand that prescribing meds for something you don’t treat could present liability. But the same information can be given in gentler, kinder, ways.

Because I want people to like my doctor as much as I do, I offered to suggest possible changes, and he agreed to consider them. Here then is my humble offering:

1. Ask potential patients orally, when they make an appointment, to please bring current insurance cards and co-pay. Cushion this with a little explanation: “Because insurance changes every year, we’ll need to make a copy of your insurance cards when you come.” Combine this with “We appreciate that you’ve chosen Dr. _______ as your specialist and look forward to meeting you,” said with a smile in the voice.

2. Take paper notices off the walls and hand a single sheet (see below) to people when they fill out their initial forms. Walls are for pictures, not warnings.

3. Combine all information that’s not obvious into one page. Skip the obvious altogether. If it doesn’t fit on one page there are too many rules! Example: No need to list all the meds you won’t prescribe. Such a list will always be incomplete. And saying you MUST fill out your forms is obvious. If somebody misses a form, the receptionist just hands it back and asks her/him to please complete it. And eating in the waiting room? Is that really an issue? What about diabetics?

4. Substitute a positive alternative for the negative prohibition. “We appreciate payment on the day of service.” Or, “We are sorry but we can only prescribe ______ meds.” If a patient asks why – okay, then blame it on the lawyer!

Remember, patients visiting a doctor are often anxious and afraid. They may be very sick. The doctor may have to deliver bad news. How about a little TLC? A little honey?

Carolyn

TALKING ABOUT RACE

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On July 19, 2013 President Obama gave a deeply personal speech about race relations. The occasion was the acquittal of George Zimmerman in the killing of Trayvon Martin, an unarmed African American teenager – and the differing responses to the verdict from the white and black communities.

Obama spoke informally, without teleprompters or script, at a surprise press conference. He spoke from the heart.

The president was addressing two audiences: he wanted white people to understand why black people felt so strongly that the verdict was unfair. And he wanted black people to know he really did understand, because “I could have been Trayvon Martin.”

The president never mentioned the word “anger.” Instead, he spoke about pain. He didn’t label anyone a racist or criticize the jury’s verdict. He talked about lived experiences – his own and those of others – of growing up black and male in America. Being followed in department stores. Seeing women hold their breath and clutch their purses when he got on an elevator. Hearing the “click” of car door locks as he approached.

Obama’s talk was a perfect example of an “I” message: name what happened, how it affected you emotionally, and why. One simply talks about one’s own experience and emotions. No name-calling, no blaming, no threats. An “I” message doesn’t frighten the other or put him or her on the defensive. It allows the other to really hear, to make a heart connection, to arouse compassion, to feel with. The aim of an “I” message is not to prove the other wrong, but to build deeper understanding.

An “I” message – whether about race or any other hot -button topic – invites real conversation, not debate. It creates a safe space to share mutual vulnerability. It’s hard to argue with someone else’s pain, but hearing it makes it easier to open up about one’s own. This is one way – a very good way — for reconciliation to begin.

Carolyn

Reaching informed Decisions about End of Life Planning

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I recently learned that a dear friend has chosen hospice care over yet another round of debilitating chemotherapy. It was an enormously tough decision for her and her family. She’s not that old (66), and her zest for life is infectious to all who know her.

Thousands of Americans confront this decision every day. Most say they want to die at home, yet 75 percent end up dying in hospitals or nursing homes. More often than not they opt for hospitalization, I believe, because they and their family members are unaware of the risks involved with aggressive, expensive treatments that may rob them of their quality of life. Did you know that such life-prolonging care accounts for 30 percent of total Medicare spending? Astounding!

Now, imagine if you could view short videos that graphically depict what happens when you undergo emergency, life saving measures that risk robbing you of any quality of life and could result in your remaining in a hospital until you die.

These short films demonstrate what goes into such treatments as emergency CPR and breathing tubes. They have undergone rigorous review by leading experts in medicine, geriatrics, oncology, cardiology, ethics, and decision-making. Clinical studies show that patients who have viewed these videos have overwhelmingly opted out of costly, life-prolonging treatment.

Produced by a nonprofit foundation comprising clinicians dedicated to educating patients about their choices for medical care, they are used by 40 healthcare systems throughout the US. One healthcare officer commented that the videos “help physicians, their patients, and their patients’ families address the issues they need to face around end-of-life care, and make more informed decisions.” Another reported that the videos “…ensure that patients have the information they need to be active in shared decision-making, and to help physicians understand patients’ values and preferences so they can arrive at the right decision together.”

For more information check www.acpdecisions.org. ACP Decisions was founded by Drs. Angelo Volandes and Aretha Delight Davis.

Sig

How to Talk to a Guy With a Gun?

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Like most of the U.S. public I was transfixed this week by the fast-breaking news of the Boston Marathon bombing and the dramatic pursuit of the bombers. In their attempt to escape, the killers carjacked a Mercedes, forced the driver to withdraw cash from an ATM, and then let him go. Police have not told us his name, but he is one of the luckiest people alive. Amidst all the heartless murder and carnage they caused, the killers let him walk away unharmed.

Why? Did he say something to the Tsarnaev brothers that triggered a human connection? If so, what might it have been?

I remembered a story my pastor, Gordon Cosby told. Coming home one evening after a meeting he and his wife Mary smelled cigarette smoke as they approached their front door, purposely left unlocked. They’d been working with recovering alcoholics who smoked, and they thought perhaps one of them was inside, needing to talk.

Instead they were greeted by a man with a pistol, who ordered them to sit on the couch. Gordon’s unexpected response: “You don’t have to be afraid. We won’t hurt you.”

Unknown to Gordon and Mary their captor man was an escaped convict who had already terrorized and robbed several neighbors. Mary offered him tea. Gordon spoke of God’s love and forgiveness. “I’m a pastor of a little community that helps people in trouble. We can get you a lawyer. If you go to prison we’ll visit you, help you get a job and a place to live when you come out. Your life can change.”

The gunman seemed to be thinking it over.  He kept them on the sofa all night long, but left them unharmed the next morning, taking nothing. Within 24 hours he was killed in a shoot-out with police.

Another true story: in the summer of 2010 an armed and masked robber invaded a back yard patio party on Capitol Hill. He held a gun on a 14-year-old girl and collected everyone’s money and jewelry. Then the hostess asked, “Would you like a drink?” The robber thought about it for a minute, holstered the gun, pushed up the ski mask, and sat down to join the conversation. After a few minutes he said, “I think I came to the wrong house. I’ll be leaving now. But before I go, can we have a group hug?” [I am not making this up.] Then he left, without the loot.

Gordon and Mary, like the Capitol Hill hostess, found a way to recognize and connect with their captors’ humanity and to inspire a different behavior, if only temporarily.

The next time I feel threatened, emotionally or otherwise, I hope I can remember these three things: help the other feel safe, show respect, and offer a vision of hope. Is that what the Merecedes owner did?

Carolyn