Couple Faces Separation in Nursing Home

As I continue to mourn my father's death eight months ago and witness my mother's slow, seeping decline in her assisted living facility, I am becoming acutely aware of not only mortality, but of the gnarled and hazardous path you have to walk to get to the end of life. How many people get to die quietly, in their own beds, holding the hand of their beloved? The story below about an elderly couple facing separation from each other because of institutional regulations and efficiencies makes me very afraid.

Do you have stories to tell about this issue? What are your thoughts about your own mortality road? How do you want your end to be? These are questions we rarely say out loud, or write. They frighten me as I type them. But I am interested in your thoughts.

Here is an excerpt from the story by Max Harrold in the Montreal Gazette, June 25, 2010

Couple Survived the Holocaust; Now Faces Separation at Nursing Home

"They survived the Holocaust, but now Elena and Francisc Basch - married for 65 years - face the prospect of being separated in the Côte de Neiges nursing home where they live in adjacent rooms.

The case highlights the difficult choices faced by long term care facilities and the often disorienting consequences for frail residents. The couple's son says separating them - both his parents have Alzheimer's - would be too traumatic. The nursing home says it is legally entitled to do what it feels is best, based on each resident's needs.

The Baschs, both age 90, have different stages of the illness that impairs memory, thought, speech and can lead to complete helplessness. The Montreal Jewish Eldercare Centre says Elena must be moved to a different ward as soon as possible because she needs a more advanced level of care, her son Max Basch, 59, told The Gazette this week.

"They cannot survive without one another," explained Max, from his home in Tenafly, N.J. His mother's more advanced condition makes the familiarity of her surroundings critical and her husband in the next room is a big part of that, he said.

"They always hold hands," Max said. "They kiss each other. They're this incredible, great couple in theirs 90s. When he went to the hospital for a few days, she said 'Maybe I can go to the hospital and check in on him and cook for him.' She doesn't realize exactly where she is but she knows they are together."

WHAT BRAIN SCANS CAN TELL US ABOUT MARRIAGE

From the June 4, 2010 New York Times, by Tara Parker-Pope. The article doesn't look at marriages in which one (or both) partner has an illness, but it's still food for thought.

WHAT BRAIN SCANS CAN TELL US ABOUT MARRIAGE
"....academic researchers have become increasingly fascinated with the inner workings of long-married couples, subjecting them to a battery of laboratory tests and even brain scans to unravel the mystery of lasting love.

Bianca Acevedo, a postdoctoral researcher at the University of California, Santa Barbara, studies the neuroscience of relationships and began a search for long-married couples who were still madly in love. Through a phone survey, she collected data on 274 men and women in committed relationships, and used relationship scales to measure marital happiness and passionate love.

Dr. Acevedo expected to find only a small percentage of long-married couples still passionately in love. To her surprise, about 40 percent of them continued to register high on the romance scale. The remaining 60 percent weren’t necessarily unhappy. Many had high levels of relationship satisfaction and were still in love, just not so intensely.

In a separate study, 17 men and women who were passionately in love agreed to undergo scans to determine what lasting romantic love looks like in the brain. The subjects, who had been married an average of about 21 years, viewed a picture of their spouse. As a control, they also viewed photos of two friends.

Compared with the reaction when looking at others, seeing the spouse activated parts of the brain associated with romantic love, much as it did when couples who had just fallen in love took the same test. But in the older couples, researchers spotted something extra: parts of the brain associated with deep attachment were also activated, suggesting that contentment in marriage and passion in marriage aren’t mutually exclusive.

“They have the feelings of euphoria, but also the feelings of calm and security that we feel when we’re attached to somebody,” Dr. Acevedo said. “I think it’s wonderful news.”

So how do these older couples keep the fires burning? Beyond the brain scans, it was clear that these couples remained active in each other’s lives.

“They were still very much in love and engaged in the relationship,” Dr. Acevedo said. “That’s something that seems different from the Gores, who said they had grown apart.”

Indeed, if there is a lesson from the Gore breakup, it’s that with marriage, you’re never done working on it.

Brushing your teeth may prevent disease

It may seem an unusual link, but doctors have found that people who brush their teeth daily are much less likely to develop heart disease than those who don't.

A new study from the BMJ revealed that people who never or only rarely brush their teeth twice a day are up to 70% more likely to develop heart disease.

Although scientists have long suspected a relationship between gum disease and heart problems, this is the first study to high the dangers of poor oral hygiene.

Experts are unsure of the exact reason for the link, but suggest that it may be a result of inflammation in the mouth and gums, which they believe is connected to the build up of clogged arteries.

However despite the findings, the researchers stressed that the overall risk of heart disease from oral hygiene remains relatively low.

In the survey of more than 11,000 people, just 71% said they brushed their teeth twice a day and only 62% said they visited the dentist every six months.

What Do You DoWith Your Anger? continued

In my last post, I wrote about the power of anger. In this post I write about some of the ways anger can be handled so that it has a better chance of being heard and responded to.

Here are some of the options I use. You decide what's best for you.

Pick your battles. Decide what you can let pass, and what you really need to address. And when you address it, preface it by saying something like, "I need your help and some uninterrupted time with you. I have been holding something back and I think I need to share it with you. It may be hard to hear, but if I don't talk about it, that will be worse. This is all in the spirit of clearing the air. When would it be a good time to talk?" By framing it in this way and by including your partner in deciding when to talk, you give him some sense of control and reduce the instantaneous defensiveness which could otherwise erupt.

Write it down. In your journal. In a letter you don't send. Write fearlessly without stopping. After you see what you have written, you can pick out the pieces that can form a more coherent message. That's the message to share, not the rant.

Talk it out with a neutral party -- a friend or a counselor. This is the safe place to unleash full bore emotion. When it's run its course, extract the message to share with your partner, find a quiet time, and frame it well.

Shout it out. Find a time when you are alone. Go to the room in which you feel the safest. Shout out your anger. Say all the things your feel and think, no matter how hurtful and ugly they sound. Shout out: "I hate you." "You're a (expletive of your choosing) ." "I can't go on like this anymore." Drain yourself. If you're concerned the neighbors will hear you, shout into a pillow or into your mattress. Then extract the key messages and set up a time to talk with your partner.

The purpose of these options is not to strip out all emotion from your message. You should not neutralize all your energy and become robotic. The purpose is to get clarity.

Anger is a loud emotion and can drown out wisdom. Anger can drive you to win the battle and lose the peace. If you no longer care about your partner and only want to obliterate him and any chance of reconciliation, then blast away. But if you want to be heard, if you want your partner to try to behave differently, if you want to build a bridge, then blasting won't get you there. Do what you can to divest your rage of its venom. Then approach your partner, with a cleaner anger, with clarity about what you need, and with the love that makes you want to stay connected.

What do you do with anger?

What Do You Do With Anger?

In Shakespeare's The Tempest, Caliban hates Prospero. Caliban, born savage and deformed by the witch who used to inhabit the island, is now a slave to Prospero, the new ruler and severe taskmaker. In this soliloquy Caliban holds nothing back:

All the infections that the sun sucks up
From bogs, fens, flats, on Prosper fall,
and make him By inch-meal a disease!

This is anger, in all its graphic, metaphoric brilliance. While we may not be as expressive as Shakespeare, illness can make us damn angry.

The ill partner can get rabidly angry at the illness that has so constricted her life. She can get angry at her well partner for still being able to go out into the world, unfettered by pain or weakness. She may also get exasperated at her well partner for making her wait until he finishes watching the baseball game to bring her food or help her to get to the bathroom. She may be silently enraged at him for all the things he can still do that she cannot.

The well partner may be furious at his ill partner for changing the relationship contract without prior approval by him. He didn't sign up for years of caretaking and even less for losing the strong woman he hoped to travel the world with.

Both partners are bound to get angry at the health care system for all the ways it makes them wait or feel insignificant or suffer unnecessary complications. This form of anger can become a full time job. Rage at the system can easily overwhelm the more fragile tenderness that both partners yearn for from each other.

How can both ill and well partner deal with these forms of anger, and others? Squashing or denying it doesn't make it disappear. It only condenses it into rock hard pellets that lodge deeper down inside the body and slip out unexpectedly to cause more piercing damage. Giving free reign to anger is like unleashing a perpetual tornado. For a moment it can seem magnificent, but it will ultimately destroy everything you value.

So, what is the middle ground between silence and vengeance? When you are in the grip of anger, all you want is to unleash it, maybe even to cause some damage to the person you feel has been damaging you. Or silence it with a heavy hand. But this will not get you what you want. What you want is validation, acceptance, understanding, and reparations. To get even some of that, you need to see your anger not as a lightening bolt you hurl at your partner, or as a fire that burns you from within, but as a bridge that needs to be rebuilt between the two of you. Something broke, and it needs to be mended, by both of you, together.

In the next post I will share some of the options I use.

What do you do with your anger?

The best ways to lower blood cholesterol

A natural way to lower cholesterol level and get a healthy body 
 weight is through the establishment of an exercise regimen. Exercise is an effective way to achieve healthy cholesterol levels. It sets off a series of enzymatic reactions in the body that increase HDL and lower triglycerides. Exercise - especially aerobic exercise done over a sustained period of 20 to 30 minutes or so at least 3 days per week - can raise the level of "good' HDL cholesterol by 5-10%. Another fact that has been known for a while is that exercise can lower levels of blood triglycerides. Therefore regular aerobic exercise, walking, jogging, biking, say 3 times per week for 30 minutes even at only 50% of aerobic maximum will burn up triglycerides while stimulating more HDL.
BlogCatalog

Grand Rounds

is up at Better Health. It's a good collection of this week's posts from the health care blog world.