With the holidays fast approaching, what comes to mind? The scent of pine, fruitcakes, latkes, fasting, the seven principles of Kwanzaa. What about stress? Crowds, too many family gatherings, pressure to buy gifts with money you don’t have – all kinds of stress. Sorry to be a downer, but during this time of year I can’t help but think about the consequences of stress.

Though it’s an act of survival, meaning we either flee from or fight against harm, stress also speeds up the aging process. It wreaks havoc on the brain, heart, skin, and more. Of course, if we think about aging long enough, and what might happen as we age, we become stressed. Many of the older people I met during my stint as a wellness nurse for the aging population used to caution me, “Don’t get old, it’s no fun.” So aging itself causes stress. Michael Verano, a therapist who writes and speaks a lot about stress, and calls himself a “stress therapist,” calls this the “chicken and the egg scenario.” In other words, what comes first, stress as a result of aging, or aging as a result of stress?

Verano also asks why seemingly intelligent people “have stress reactions when they know the reaction will have no impact on the situation?” For me, I know, intellectually, that there is no reason to worry about the negative outcomes that might occur in advance of, say, a lecture about writing I’m giving a week from now. My imagination has a way of coming up with the all kinds of dire scenarios: What if I forget my notes? What if I bore the audience and everyone falls asleep? What if someone says I don’t know what I’m talking about?  What if, what if? So, mentally, and emotionally, I worry.

Maybe my worrying is how I cope? Is it how you cope? Verano suggests that most of us believe stress is a coping mechanism, and he has gathered a list of statements to support that exact sentiment. For example, expecting that something bad will happen helps reduce the emotional pain if that negative outcome does occur. With this in mind, Verano came up with ideas to counter-act what he calls a “sea of stress.” My favorite one is putting a time limit on stress reactions. Verano encourages us to set a timer for, say, fifteen minutes, and freak out. But he cautions us not to do so around expensive items, or in public places. If we did, then we might really have something to stress out about.

Now that I’ve pressed you to think about your own stress level and, therefore, have most likely made you stressed, I hope this post helps.

Happy holidays!

Since November is National Alzheimer’s Disease Awareness and Family Caregivers Month, I thought I would take the opportunity to thank the more than fifteen million Alzheimer’s and dementia caregivers in the United States for their hard work. You are to be admired, and applauded.

More than forty million people worldwide have Alzheimer’s disease. Included in that number is my father, and perhaps your own parent, grandparent, spouse, or best friend. Because I often feel helpless when I visit my father in the nursing home as I listen to him stutter my name, and watch his hand shake as he tries to lift a scoopful of ice cream to his mouth or turn the page of the newspaper, I must reach out to you. I reach out with the ice-cold truth about this insidious disease that pisses me the fuck off, and makes me want to punch the protein out of its plaques and tangles. (I’m not a violent person at all, really. But watching a loved one slowly fade into the dark more than sucks.)

Now that I’ve purged from my gut how I really feel, I’d like to share with you what Dr. Samuel Cohen, a Research Fellow at the Centre for Misfolding Diseases in the Department of Chemistry at the University of Cambridge, has to say in a video about Alzheimer’s:

By 2050, Alzheimer’s will affect one hundred fifty million people.

If you plan to live into your golden years, your chance of developing Alzheimer’s will approach one in two.

Alzheimer’s is the most expensive disease in the United States, costing two hundred billion dollars each year.

Out of the top ten causes of death worldwide, Alzheimer’s is the only one that cannot be prevented, cured, or slowed down.

The US government spends ten times more on cancer research than on Alzheimer’s.

People with Alzheimer’s can’t always speak out for themselves.

Alzheimer’s is always fatal.

Alzheimer’s is not a normal part of the aging process.

If you have a brain, you are at risk for Alzheimer’s.

We now know that the plaques and tangles clogging the Alzheimer’s brain consist of protein molecules.

We can cure Alzheimer’s.

To hear Dr. Cohen’s TED Talk about Alzheimer’s and the new class of drugs being tested to stop the disease, please click here.

I’m over-the-moon excited to announce that my essay, “Reaching for the Keys,” has been published in Saranac Review  It’s about my emotional struggle to take the car keys away from my father, who was diagnosed with Alzheimer’s disease in 2012. I spent a year and a half working on it – typing, deleting, reflecting, pacing, tearing up drafts and starting over, pulling my hair out, waking up in the night to scratch down notes. Why all the fretting? Though any piece of creative work takes time to craft into a piece of salient art, writing this essay challenged me more than most other essays I have written. How so? While I know I made the right choice by taking the keys away from my father, the act of writing the essay brought me uncomfortably close to particular emotions and a long list of complexities that speak to the human condition (at it’s core, what this essay is really about): fear, anger, remorse, guilt, truth, loyalty, mortality, illness, aging, independence. I suppose that’s partly what creative writing should do – push us a little too close to the edge of the metaphorical embankment.

There’s also an ironic element to the piece, but I don’t want to give too much away here (apologies for the teaser). To quench your curiosity, relieve your hunger, I encourage you to read the essay. The Journal is available for purchase at: Saranac Review.

The Saranac Review was born in 2004 out of four writers’ vision to open a space for the celebration of many voices including those from Canada. Attempting to act as a source of connection, the journal publishes the work of emerging and established writers from both countries. As our mission states, “The Saranac Review is committed to dissolving boundaries of all kinds, seeking to publish a diverse array of emerging and established writers from Canada and the United States. The Saranac Review aims to be a textual clearing in which a space is opened for cross-pollination between American and Canadian writers. In that way, we aim to be a textual river reflecting diverse voices, a literal “cluster of stars,” an illumination of the Iroquois roots of our namesake, the word, Saranac. We believe in a vision of shared governance, of connection, and in the power of art.

~ Saranac Review

When people learn that I am a writer, they say, “I could never write, I have nothing to write about.” But that’s not true. Stories and narratives are everywhere, even in the narrowest cracks and folds of one’s life. If you can listen, you can write.

When I worked as a wellness nurse, I visited with more than a dozen residents, eighty or older, at independent living facilities. After checking their vital signs, I asked them if there had been any changes in their medications and health I should know about. Mostly, I listened to them share stories about their grandchildren and great grandchildren. Of course, I also listened to their woes. On my pad, I scribbled phrases such as “I wish God would take me already” or “Oh my achin’ legs. I got no legs anymore.” Those captured words were as essential to my work as the blood pressure cuff and stethoscope I used to check the residents’ vital signs, because behind those woes were hidden gems. For example, I remember the day eighty-seven-year-old *Sharon said, “The leaves are quiet.” Sadness oozed its way into my limbs, turning them limp, for what I heard Sharon saying was, “I long for my younger years.” I heard that longing when the lilt in her voice fell on the word “quiet.”

Virginia Woolf said, “Behind the cotton wool is a hidden pattern; that we—I mean that all human beings—are connected with this; that the whole world is a work of art.” In other words, the stories the residents shared made up the hidden pattern behind Woolf’s “cotton wool.” Their stories were an integral part of my writing, thus my own work of art. Their words were an art in and of themselves; they were metaphors for, say, loneliness, hope, fear, all the stuff that comes with aging, and dying.

Let’s take a look at ninety-six-year-old *Martha. During one of my visits with her, she told me she had written her own obituary.“I want to make sure I have as much set before I go so my family isn’t burdened with too much. Would you like to read it?” She pushed it across the table toward me. I couldn’t say no.

I don’t recall the details of what she wrote, other than her list of achievements: a college graduate, a teacher and volunteer, and an active member of her church. Martha told me she knew her time would end soon, that she was ready and had no complaints about the life she had lived. Understandably, talk of death isn’t easy; most people avoid it as if it were a highly contagious virus. But I made a point to listen to her because she needed listening to. What I heard behind the “cotton wool” of Martha’s words was a woman who not only pined to share her acceptance of death, but her anxieties, fears, and curiosities about death itself.

If we allow ourselves to hear the real story behind the “cotton wool,” surely we can weave a tapestry together.

I’ll end this post with a writing exercise for you (not mandatory, but highly recommended). While in a café or restaurant, or in any public venue, listen closely to the conversations taking place nearby. Note what is being said. Think about it for a while and see what kind of tapestry you come up with.

Good luck!

 *To protect privacy, all names are false.

Are you in need of an elder care agency for a loved one, but don’t know what you should be looking for? I’m here to help you get started.

A few years ago, when my father began to experience cognitive decline and difficulty with organizational and household tasks, he was diagnosed with Alzheimer’s disease. He became anxious when left alone, even for a short amount of time, so my family decided to hire a home health aide.

The agency we chose didn’t charge too much for caregivers, and they could take him out to lunch or to do errands. But personalities between my father and the few caregivers on staff didn’t mesh, so we hired a different agency about a month later. These caregivers lasted six weeks before they burned-out. After a lot of research, we found a larger agency with several caregivers and years of experience caring for people with Alzheimer’s. Because of reasons too complicated to discuss here, it took more than a year before the agency found a few caregivers that my father felt he could trust. And, in the event of illness, there was a large pool of others to fill in. The agency assigned a nurse case manager to oversee the caregivers, to trouble-shoot glitches in schedules, and to coordinate medical appointments. More than two years later, due to policy changes and poor communication from management regarding updates about my father’s condition, we fired them and hired another agency. That was about a month ago and, so far, things are working out well (I’m keeping my fingers crossed).

If you’re in search of an elder care agency, I’ve gathered a list of questions to ask whoever is in charge. But, first, it’s worth noting that private home care agencies are for-profit businesses; they’ll work hard to convince you that they’re the best ones to oversee the care of your loved one. So, before signing your name to a contract of any kind, think of the following as an interview – you do the interviewing:

1)  “Does your agency accept Medicare?”

If the services being provided are for activities of daily living – bathing, dressing, feeding – Medicare will not pay. They will only pay if skilled services like dressing changes or physical therapy are needed. Most likely you, or whoever is receiving care, will either have to pay out of pocket or use long-term care insurance, if you are fortunate enough to have a policy (see #2).

2)  Is your agency registered with the state?

Long before he was diagnosed with Alzheimer’s, my father  bought long-term care insurance, in the event he would need care for an indeterminate amount of time. His policy doesn’t cover the cost of care with agencies not registered in the state in which he lives. I didn’t know this until after we hired the second agency, which was not registered. But Long-term care polices can be costly. I recently learned that most companies no longer offer insurance because they don’t have enough funds to pay benefits; however I heard that New York Life still does.

3)  Does your agency meet federal requirements for safety and health?

4)  How long has your agency been in business and do you have experience caring for people with Alzheimer’s, etc.? What are the primary services your agency provides?

5)  How experienced are your caregivers? Can I see references?

6)  How often do you conduct performance reviews? How are your home health trained, and how do you monitor their skills? Are they licensed? How do they handle emergencies like choking or a heart attack? Are they trained in CPR?

7)  Are caregivers able to drive clients to appointments, to lunch, etc.?

8)  Is there a lot of employee turnover? If so, why?

9)  Are you affiliated with local hospitals? If so, which ones?

10) Do you have case-managers? How often do they visit clients? Will they go to medical appointments? Are they available for emergencies? What are the fees for these services?

Depending on the agency, the fees can range between $125 and $165 per hour. Though it’s expensive, if your family can afford it, it’s worth it.  Case managers help coordinate all aspects of care, including assigning caregivers, and following-up with physicians. And they advocate for their clients.

11) What are the fees for caregiver hours?

12)  How often do you bill? Do you bill directly to long-term care insurance companies, or do clients have to pay upfront?

13)  How do you communicate with family? By email and/or phone. How often? Who are you allowed to speak with? All family members, or just a designated individual like a health care proxy or legal guardian?

If you’re the one designated to speak to the case manager and other staff, I urge you to remind them to send you updates on a regular basis, otherwise they will forget. Remember, you are your loved one’s voice.

Feel free to offer feedback.

Good-luck!

During a visit with my father last October, I experienced a moment of mutual presence with him, a moment so rare between the two of us that I had to write about it, not only for me, but for you. Do you have a similar experience you are in need of sharing?

Bananas 

While I eat lunch with my father today, he stares at the bunch of bananas in front of him. “They’re so beautiful,” he says. “Their so yellow.” He smiles, then giggles. Who is this man?

Before my father’s dementia started progressing a few months ago, he never noticed the details of anything beyond his checkbook or savings account. We certainly never discussed the aesthetics of fruit. But maybe the plaques in his brain are leaking a chemical that allow my father to be deeply aware of seemingly mundane things like bananas.

He takes a bite of his sandwich, then comments on the bananas again: “I can’t believe how yellow they are.”

Until my father’s uncharacteristic awareness, I never looked closely at the beauty of bananas: cylindrical bodies, tapered ends, and sturdy stems attached to inflorescent stalks. When I eat a banana, I usually strip the peel off, whip it in the trash, and devour the fruit. I grab a banana on the go, when rushing to an appointment, or when driving to work. After I’m finished, I throw the peel on the passenger side floor mat, or stuff it into the cup holder.

My father touches the top banana, lightly, as if taking care not to disrupt its serene poise, yet needing to feel its yellow presence. I ask him if he wants one. He pulls his hand back. “No, I just like looking at them,” he says. And so we look at the bananas, together.

Bananas was previously posted at  Beautiful Things, a weekly column by River Teeth: A Journal of Nonfiction Narrative