compartments undone

I've mentioned E.F. Schumacher's Small is Beautiful on a number of occasions throughout TOA's history - once in a 2017 reading review, and again in a 2018 post. The latter may seem superfluous on first glance, but since I didn't mention intermediate technologies in 2017, I suppose it was only a matter of time before I rectified the omission. Intermediate technology has a certain "official" definition in the context of development economics, but I've managed to distort it over the years into terms I can use within the context of my own life - I now think of it as the achievable short-term target within the process of reaching a larger long-term goal. A recent example came around this time last year when I became interested in doing pistol squats, which is a strength training exercise that resembles a full squat on one leg. I came across a blunt insight while researching the movement - if you can't do a full squat while using both legs, it's simply impossible to do it on one leg; I forgot all about the pistols and turned my attention toward the full squat.

The pandemic must have forced me out of this habit of reframing larger problems in terms of smaller, achievable targets because I was caught-off guard last week by an innocent question - how should hospice volunteers respond when they are uncomfortable with a new resident? The question lingered in the air for a few moments, threatening to become its own example, but I soon realized the problem with the premise - it reminded me of the way I first thought about pistol squats. I think the biggest issue for a hospice volunteer is thinking about the role as some version of life that happens entirely apart from everything else, like trying to support all of your weight on one leg before you can do so on two. It becomes yet another moment where we divide ourselves, leaving our accumulated experience and wisdom at the door; I think compartmentalizing is healthy, but only in brief spells, and always with the intent to reunify as quickly as possible.

One way to think about a challenging situation, like the first few shifts in a new volunteer role, is to frame it like an athlete approaches the game, the student approaches the exam, or the artist approaches the performance; the problems that arise on the big occasion should then inform the rest of your life, which is like training, studying, or rehearsing before the next shift - if you learn on your first assignment that you can't cook, you go home and cultivate those culinary skills in your kitchen. It's all about understanding the big target - becoming a great volunteer - and thinking about it in steps that give us a plan for the day. This is the feedback process, this is the performance improvement approach, this is the commitment to growth and personal development that eludes us when we compartmentalize for too long, which makes it impossible for the volunteer to understand the razor-thin margins between the shift and the rest of his or her life.

reading review - lost in translation, part five (finals)

Howdy,

As per the disclaimers seen so far in this series, if this post doesn't already make sense to you, follow these links and get caught up:

The Lost In Translation bracket, 2020 edition

• 9/20 - Intro and 1st Round
• 9/25 - Quarterfinals, part one
• 9/29 - Quarterfinals, part two
• 10/9 - Semifinals

For the rest of us, on to the finals, which I think is best presented in a head-to-head format...

Iktsuarpok (Inuit) – noun, the act of repeatedly going outside to keep checking if someone (anyone) is coming.

-vs-

Hiraeth (Welsh) – noun, a homesickness for somewhere you cannot return to, the nostalgia and the grief for the lost places of your past, places that never were.

I went back and did a little research on the 2016 edition of the bracket for some added context about this matchup. In some ways, it's a little lopsided - iktsuarpok was the winner, while hiraeth was knocked out in the first round (final sixteen). I suppose in one way it's been a long four years, reflected in a way by the ascent of hiraeth into this final round; I suspect in the time of COVID, many readers can relate to the feeling of a vague homesickness for the past. But the fact of a repeat appearance from iktsuarpok confirms the old adage that the more things change, the more they stay the same; the word itself speaks to the sensation.

What I wrote four years ago about hiraeth holds up quite well - ultimately, the homes we miss distract us from the homes we must keep within, simply because life doesn't let us keep any other home. Home is indeed, as I referenced back then, where the hurt is, but that's partly because clutching for the material meaning of home, the time and the place of it, prevents us from living with and through our hurt in any other way, in any other place. Hiraeth is in some ways the breaking point, when a new dawn will shine a light on the rubble for exactly what it is, and give you the clarity of vision for building anew.

I felt a similar way when I looked back on iktsuarpok - I said quite a bit about it in 2016, and much of it holds up. In the first round, I wrote about the word as resilience against modernity, referencing as it does the basic human contradiction of constantly seeking ways to pass the time despite our ongoing insistence that we never have enough time. Or perhaps, as I noted in the quarterfinal, it simply restates the futility of having to wait for someone, for anyone, to bring significance into a lifetime stuck in the mud of the mundane - and of waiting while knowing that nobody might come at all. The thoughts I expressed in the semifinal were perhaps the most significant at the time, where I described the process of grief as like a period of waiting, in a land where no one will find you, until you see the return of yourself; I've only grown more appreciative of this perspective in the ensuing years.

The 2016 tournament ended on a somewhat surprising note, as I had expected komorebi to take the top prize. I remember how as I wrote I slowly worked my way to a different conclusion, the crux of it an understanding that despite its foreign origin komorebi was hardly a word beyond the American grasp, and easily translated with a certain kind of non-linguistic effort. Iktsuarpok works on a different level for it refers to something that doesn't exist in our culture, or at least has no value; we often talk in our hospice volunteer team about the counter-cultural aspect of hospice, as if participating in the institution is a certain understated form of protest, where we demonstrate against a society that expresses its fear of death through violence against suffering, defeated bodies. In hospice, people wait. They wait for their friends, they wait for their families, they wait for their God - they wait for anyone, whoever is coming, if anyone; we wait with them, and take on the role of visitor, so that the resident feels less like a visitor in their own home, and may find comfort in the sense of belonging.

In some ways, when I look at these two words I see the bones of a very similar idea - each speaks to a certain reality of transition and creates the language we need to communicate the heart and heartbreak of change. But hiraeth, though a powerful idea, places us squarely in the physical world, and moves us within its confines; iktsuarpok is an expansion, in that the physical world is reframed as the transition. I feel I've had my taste of each perspective, and I have a strong sense of which leads us to a path where we can seek belonging, and discover home, here on this earth.

Silver medal

2) Hiraeth (Welsh) – noun, a homesickness for somewhere you cannot return to, the nostalgia and the grief for the lost places of your past, places that never were.

Gold medal

1) Iktsuarpok (Inuit) – noun, the act of repeatedly going outside to keep checking if someone (anyone) is coming.

proper corona admin, vol 69 - phase four is phase one

The saddest routine news story during the pandemic was about every sick person who died alone. It reflected a necessary containment measure, but unlike the other strategies this asked the most vulnerable among us to sever the final rope that tethered them to the living world. In those dark moments, I reflected on my past four years of hospice volunteer work. Even in the best of times, it seemed someone was always about to die alone, so each week was an appeal against destiny. When the pandemic ends people will still die alone, and I'll be ready to get back to work.

I think many have felt something these past few months, perhaps manifesting as outrage, despair, or helplessness. Some tragedy hits us at the very core and we can do nothing more than shudder in the silent air of home. Hang onto that feeling, and remember it. When things return to a New Normal, the outrage, despair, or helplessness may pass, but most of the underlying problems will remain. Take advantage of a second chance, and follow the feeling until someone gladly welcomes your helping hand.

finding your best

I once read an article about dementia caregiving as part of my hospice volunteer team’s annual training program. Initially, I thought it might be interesting to read the piece, take down a few notes, and share my thoughts here in a fashion similar to how I’ve done reading reviews for books.

However, as I read along with pen in hand, I realized this would not work very well. One reason is that the advice in the article wasn’t concrete enough to write specific recommendations about. In fact, in some cases the advice seemed to contradict itself due to the classic ‘do a little of this, but also do a little of that’ construction.

I recall one example that recommended paying close attention to what a dementia patient said in order to get clues about where the person was at the moment. Sentences later, the paragraph concluded with a reminder not to pay too close attention because sometimes a dementia patient will say things entirely disconnected from recent remarks. So, listen closely… except when you don’t (1)? Great advice, thanks!

I was also a little confused because a lot of the recommendations were fairly mundane. Ask questions, be clear, stay calm, and so on. All of these ideas made sense but I failed to see why an article was required just to state these recommendations. Stay calm?? Don’t we all try to do these things by default? Whenever I’m with others, I try to ask questions, be clear, and stay calm. These don’t sound like caregiving skills – they just sound like skills.

After reflecting on the piece for a few weeks, I think I started to understand the article a little better. I realized that a lot of advice existed merely to help a caregiver build confidence in a situation that offered little positive feedback. If caregivers see themselves reflected back in the article’s examples, it would surely boost their confidence and help them become better caregivers.

Another important aspect of the article was how it outlined the many options available in responding in a dynamic, difficult situation. When no obvious best option exists, a caregiver’s biggest asset is to know as many of the options as possible. This way, a caregiver can try a number of things until one option works better than the others. It’s not as important to get it right the first time so long as the willingness and perseverance to try another option remains intact.

However, the most important aspect of the article is the subtle message that what we need to help others is already within us. We are all well aware of the need to listen closely to each other – but we also know the importance of ignoring the corrosive word. We know to ask questions, express ourselves clearly, and remain calm whenever possible – having this reinforced as caregiver advice helps us face the challenge of the new responsibility with the wisdom of prior experience.

I’ve definitely learned one or two things as a volunteer, for sure, and there are some specific tips and skills that helped me in my early days. But for the most part, I’ve just simply shown up and tried my best. I’ve relied, in other words, on identifying my own skills, strengths, and abilities and finding ways to apply those to the situation on the day. The qualities I needed to do well in the hospice environment were basically in me all along. These qualities were bubbling at the surface in some cases and buried deep inside me in other instances but for the most part I’ve found that with a little hard work I could find a way to bring the quality out of me and use it to contribute in some way.

This idea reflects the larger lesson I’ve taken away from my hospice volunteering that I wrote about last month – it’s an easy role for those who already do what a volunteer does. In some cases, it doesn’t seem like I’m doing anything at all simply because I’m just doing what I normally do. I try to pass this lesson along anytime I train or mentor a new volunteer – it’s far easier to learn how to support a sick person outside of hospice and then apply the skill on a shift than it is to do the reverse.

That said, the reverse does apply in certain ways. One change I’ve noticed in myself since I started volunteering is how it has impacted how I live outside of my volunteer shift. I’ve found that the qualities I rely on in hospice cannot be simply tucked into my back pocket when my shift ends. The fusion of my volunteer role and the rest of my life has been a great gift and I find these two versions of myself become increasingly indistinguishable with each week that goes by.

The result of this coming together is that I find myself less tolerant of the way I adjust my personality to fit different environments. I once felt I had all kinds of versions of myself – at work, at home, with a group of friends, with one friend, with strangers, and so on. I don’t think this will ever be true again. Although there is a good argument for selectively compartmentalizing, these days I feel the chameleon approach to life is an exhausting approach. It might work to always change my colors based on a situation – it might even work for a very long time. But how can I ever be my best if I run myself ragged while trying to be really good versions of five different people? I think a better long-term approach is to focus on tackling the lifelong challenge of becoming my best self and developing the confidence to be that one self at all times.

The great gift of coming into an environment that requires I be my best self at all times is that I was forced to identify my best self. I found almost right away that this is a true full-time job – twenty-four hours a day, seven days a week. There was simply no leftover time for being less than my best. I cannot think of why anyone would not benefit from finding a place that brings out the best self from within. Finding the best self should be one of the urgent tasks for any individual.

How might you do this? You might find it in a hospice-type environment like I did or you might not. The key is to think about where you’ve glimpsed yourself at your best and then find a way to go back. If you can do this, you'll soon realize that you have no choice but to be your best all the time.

Footnotes / ever notice how people who talk about moderation tend not to do so in moderation?

1. What I’m really saying is that ‘all things in moderation’ is arguably the worst advice in world history…

It’s a lot like a financial advisor saying ‘save money for sure, but make sure to splurge from time to time’ or the nutritionist saying ‘make sure to eat vegetables, but it is OK to indulge in cake from time to time’. Huh? Have we lost the plot? The whole POINT of getting expert advice is that this ‘moderation’ concept isn’t working!

volunteer fusion

Hi reader,

An infrequent but very rewarding aspect of my hospice volunteer role is my involvement in orientation for new volunteers. Orientation happens in two parts. First, there are initial training sessions with a group of new volunteers. Then, new volunteers join experienced volunteers for individual mentoring during hospice shifts (we call this ‘shadowing’).

I’ve participated in both parts of orientation and my teaching process tends to be similar no matter what the setting. First, I share my history as a volunteer and talk about some of my experiences. Then, I briefly describe some of the specific details about volunteer responsibilities in the hospice house. Finally, I make it clear that I’m willing to answer any questions.

The final part leads into my favorite aspect of the training role. I enjoy giving a good response to an honest, open question from someone who only wants to know the answer. As an experienced volunteer, I consider answering honest questions a very important responsibility. It allows me the chance to give back to a group that has been very good to me over the past couple of years by helping the team bring new members up to speed as quickly as possible.

However, I also enjoy this aspect of the role for purely selfish reasons. I often find that the process of giving a thoughtful response to an honest question is a great learning opportunity for me. As I consider the question and try to determine the right response, I open up unexpected places within me and find myself understanding a little more about what I’ve learned in my time as a volunteer (1).

The best such question I’ve ever been asked came from a new volunteer who was not sure if the role was the right fit. She asked me – how did I know I should volunteer? I had to think about that one for a short while. Finally, the answer came to me from within, out of nowhere – I knew I should volunteer because I was already doing it.

I explained my answer by pointing out how much of what I did as a volunteer – relating across differences, connecting with strangers, exhibiting endless patience, validating feelings, rejecting assumptions, and so on – were all the same things I tried to do in my life outside of hospice (2). I knew I should come to hospice because the way I wanted to live was a perfect template for the way I would volunteer.

I cut my answer off at this point because I felt I’d answered the question. However, as I think it over now, I realize there is a little more to the point. I think a lot of people who drop out of the hospice volunteer role struggle simply because they are suddenly trying to do something in a hospice environment that they do not regularly try to do outside the hospice environment. A volunteer who does not try to support suffering friends or family in the relatively familiar environment outside of hospice is going to have a very difficult time learning to support strangers and staff in the unfamiliar hospice setting. In short, hospice challenges volunteers to be their very best selves at all times, whether they are on a shift or not. This is an impossible challenge to meet for those who are not already trying to be their best self outside of hospice.

This understanding helps explain why my hospice volunteering is such a difficult idea for the people in my life to relate to. Society encourages us all to have many different versions of ourselves, to don many capes and wear many hats, so to speak. We have one persona for home and another for work. The rudeness we exhibit when behind the wheel or navigating public transit might be entirely unknown to those we interact with exclusively in work groups or living rooms.

There are valid and important reasons for all this compartmentalizing but I suspect our various situational personalities make identifying our best self a very challenging task. It certainly makes it difficult to be our best selves at all times because we are constantly switching from one self to another. How can we be at our best all the time if we aren’t always fully committed to being ourselves? It might be possible, I suppose, but I've learned over the past couple of years that it wouldn't work for me.

The ongoing fusion of self and volunteer has been one of the enriching results of the volunteer role. I’m finding now that after a couple of years as a volunteer, a lot of what I’ve learned at hospice is starting to influence how I live when I’m not on my shift. I think these days most people see the same me whether I’m in the hospice or not. That's just fine with me - the less I compartmentalize, the more time I'll have to work on becoming my best self.

Footnotes / Saturday afternoon

1. An honest question can only return an honest answer…

Another great example of how I learned from an honest question came during one of the first times I participated in a group training session. I had just finished explaining that sometimes the house could be very quiet and that it was possible to go an entire shift without interacting directly with anyone. A volunteer with a great understanding of herself then raised her hand. She explained to me that as a social person she would prefer a more active shift. What times did the house tend to have more reliable activity?

I had never thought about it before and considered all my experiences – even going as far back to when my mom was living in a hospice – before recommending midday Saturday. In the process of answering this question, I learned not just that I knew the answer but also that I’d avoided such shifts, had specifically offered my time before breakfast or in the evening, for reasons I needed to understand better if I was going to continue my growth as a volunteer.

2. And my nonconformity streak, I suppose…

The one thing I can’t quite figure out how to describe about hospice is its counter-cultural element. I didn’t consider signing up to volunteer as a counter-cultural act but the more I think about it, the more rebellious I feel for donating my time to a medical organization whose stated mission runs against the basic assumptions of the medical field.

reading review - being mortal

Hi all,

Last week, I wrote about Atul Gawande’s Being Mortal and briefly explored his insights into end-of-life options for terminally ill patients. One important angle I did not look at was hospice care. Unlike standard medical care, hospice care differs because the goal of treatment is not to extend life but rather to help the patient have the best possible day.

The thing that makes hospice such an important option for many patients is how the goal of care aligns with how people’s preferences tend to change as they age or become sick. For the most part, people’s social networks narrow over time as their dwindling horizons force them to focus more on the present than on the future. Rather than seeking to broaden their experience, people start to prefer the care and companionship of what they already know. Hospice care recognizes these preferences and tailor treatment to help patients focus on being rather than doing.

However, this approach does not suit everyone medically eligible for the hospice benefit. As we build up our system of non-treatment options for our aging population, the challenge facing hospice is to preserve the core of its treatment philosophy while expanding its horizons to meet the needs of those whose preferences do not align so well with the general ideas described above. As a hospice volunteer, it’s a challenge I look forward to meeting every time I start a shift.

Being Mortal also boasted a few good nuggets of information for helping amateur caregivers like me learn how to better interact with patients. Gawande points out how it is important to account for spine curvature when helping others eat. The elderly are more likely to have curved spines and therefore should eat looking down – if they look straight ahead, it quickly becomes a choking hazard because a person with a curved spine looking straight ahead is like anyone else looking up at the ceiling.

Also, I liked the recommendation that those who struggle to help others make good decisions during difficult situations might do well to simply try and explain their worry next time. I imagine this is due to how we never know quite as much about how another person is thinking or feeling as we like to think. The approach of expressing your own feelings can do wonders in such situations to help others understand why you are recommending a particular course of action.

Not all of the insight was purely medical. I liked some of the advice presented for how to interact with others in order to help them feel heard. First, it is important to sit or stand at eye level. There should be no desks, screens, or even tables between you and the other. Also, try not to twitch, fidget, or move around as the other person speaks. Finally, when the other person has stopped speaking, pause for a beat to confirm that the other person has stopped speaking.

One up: Gawande scatters surprising statistics throughout Being Mortal. He notes, for example, that genetics do not have the same influence on longevity as they do on other attributes – whereas height is around 90% explainable by genetics, longevity is measured at around 3%.

I also learned quite a bit from his comments about falling. A fall is one of the loudest possible alarm bells for aging or sick Americans. The biggest risk factors are poor balance, muscle weakness, and taking more than four prescription medications. A person without those risk factors has a 12% fall risk but those with all three are at close to 100%.

Some of the other uses of statistics lacked the precise numbers of the previous examples yet were instructive in their own way. One statistic showed that doctors massively overestimate their patients’ survival times. Interestingly, the likelihood of an overestimate went up the better the doctor knew the patient.

A final thought is a great summary of how statistics work in general – the variation around the middle point tells a richer story than the middle point itself. I think this insight speaks to the struggle many have when trying to pull meaningful insights out of a dataset. I think people are very capable of understanding absolute or binary metrics but have a tougher time interpreting (and applying) the lessons embedded in the variation around the midpoint.

One down: Gawande's insights into the problems of geriatricians spoke volumes about the larger problems in the medical field. This specialty does not have a natural niche in the modern medical marketplace because it does not offer to fix anything. Instead, geriatricians will help their patients increase resilience in old age and have incrementally better days in the future. This sounds nice on a silly little space like TOA but at a societal level our priorities have yet to value this approach. Until we do this, our best and brightest will continue to pursue more lucrative ventures like specialty surgery, computer programming, or shooting three-pointers.

The comments about geriatrics reminded me of an article I read years ago about the challenge of being a primary care physician. The overall thought was similar to what I’ve just highlighted about geriatrics. I still remember a line from the piece – the challenge of primary care is trusting that your patients will come back if their symptoms get worse. In ‘the modern medical marketplace’, it is hard to think of a good way to reimburse doctors who can earn their patients’ trust, right?

Just saying: I thought the idea that living things offer an alternative to boredom simply because of their spontaneity was a very effective way to explain the importance of something most of us feel no need to explain. It isn’t necessarily important to explain everything we take for granted, of course, but I think it is a useful habit to get into because being able to articulate important concepts with simple explanations is the essence of helping others understand the world.