Gradual Grief

Gradual Grief

Wednesday, November 29, 2023

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Photo: freeimages.com hourglass-7-1312469.jpg

INTRODUCTION: 7 August 2023

     The article that describes our journey over the past three decades is the context for this essay (see "Our Journey" page in the top dashboard). I definitely recall acute feelings of loss at several steps along the way: when Mike was put on disability, when palliative care was recommended, and when he was admitted to hospice. Although his condition continued to decline, he was discharged from hospice after two and a half years. Re-evaluation was requested, but hospice care was deemed not appropriate. I find myself trying to navigate an emotional balance, without extreme highs or lows. 

GRADUAL GRIEF

By Gail K. Kachnycz; 11 March 2021 

     Chronic illness is a series of losses, and each is grieved in turn. First, with the identification of a diagnosis, there is the loss of the state of good health that the person previously enjoyed. Additional symptoms, and each decline in functioning, is a need for an adjustment of perspective which is quite often coupled with an emotional response. When death finally comes, the family or caregiver might actually experience a sense of relief.

     An unexpected death usually brings feelings of shock, disbelief, and an overwhelming sense of loss. There may be deep emotional pain. The survivor may feel numb. Mourning a loss is different for every person. There is no right or wrong way to grieve.

     In chronic illness, the affected person and caregiver or family may experience feelings of loss over time. This may be gradual, or may be attached to specific signs of decline: a person with dementia does not recognize family members, a diabetic requires an amputation or needs dialysis, the doctor says, “We can only manage symptoms, no cure is possible,” or “We don’t expect improvement,” or “You may want to consider hospice.”

     Each decline initiates a new period of mourning, but remaining in an acute stage of grief is unsustainable. Life goes on, with bills to pay, cooking, laundry, and so forth. Eventually, there is an adjustment to the new normal. However, the person may find that they are protecting their emotions from extreme highs or lows. This is a natural coping mechanism. This may be a sign of “Compassion Fatigue” and indicate that the caregiver needs some time and means for self-care.

     When death finally comes, it may seem to others that the family or caregivers have only a brief period of bereavement and recover rather quickly. Quite the opposite is true. The family/caregivers have been grieving for months or years as they watched their loved one slowly slip away from them. At last, the process reached the end, and the family can say their goodbyes and move forward. This is not to say that the funeral, burial and settling of affairs will not be difficult, but at least closure can take place.

     Grief is not an “all or nothing” process. Especially since chronic illness is ongoing, the ill person and their family will find that happy events and silly situations are also taking place. This is the nature of life. In 1859, Dickens had it right as he penned A Tale of Two Cities: 

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way—in short, the period was so far like the present period that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only. 

     Those dealing with chronic illness can immediately empathize with those who are encountering the same struggles. Their support and comfort to others rings true. 

“…we can comfort those in any trouble with the comfort we ourselves receive from God.”

2 Corinthians 1:3-4 

     However, happy events and positive growth are taking place at the same time. Recognize these opportunities and celebrate them. Just as we mourn with those who mourn, we rejoice with those who rejoice (Romans 12:15). We can do this not by ignoring the effects of chronic illness, but recognizing that although there seems to be no end in sight, ultimately there is something beyond what we can see. 

“Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal.” 2 Corinthians 4:16-18

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Working and Caregiving

Working and Caregiving

Wednesday, November 22, 2023

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Photo: klsmith77 1314832.jpg
 

WORKING AND CAREGIVING

By Gail K. Kachnycz; 1 April 2021 

     Chronic illness affects not only the person who is diagnosed with a medical condition, but all the members of the family in different ways. If the person experiencing progressive illness is the primary breadwinner, and needs to work fewer hours or actually apply for disability benefits, the family income will be affected. The whole family should be included in talks about finances. There are emotional and spiritual effects as well. Here are some examples of how different family members may be impacted:

      FINANCIAL:

·         Income may be reduced due to decreased hours or disability benefits.

·         The spouse may need to continue working, begin working, or take on an additional job.

·         Medical insurance and medical bills will be a big part of the picture. The decision to work, and how much, may depend on if the job includes medical insurance as a benefit.

·         Children need to understand that they may need to earn the money for sports activities, school trips, and so forth.

·         Children of high school age may need to seek part time employment to fund their activities, save for college/job training, or even contribute to some of the family expenses (for example, if they use the family car they may contribute to the cost of car insurance as well as paying for gas).

·         Everyone may need to look at ways to live more economically. Examples: walking/biking/riding public transit, checking thrift stores for clothing. 

EMOTIONAL:

·         The primary breadwinner who must decrease hours due to illness may feel they have let the family down.

·         Any of the family members who must seek employment to make up the lost income will have the added stress of the job search, and then training when the job starts. If the added income is from a home business or self-employment, there is stress of launching the business.

·         There may not be enough income for mortgage or car payments. Decisions about selling a car or house can be draining. Relocating to a more affordable dwelling may mean uprooting from the church fellowship, enrolling children in new schools, and leaving neighbors who have become friends.

·         Bills may accumulate until a new source of added income is secured. This may result in higher interest rates, bills going to collections, and damage to the credit rating. Stress, stress, stress!

·         If the caregiver is employed outside the home, there is concern about the loved one managing at home alone.

SPIRITUAL:

     Worry about finances, concern about the health of the loved one, and the stress these forces place on the family all have spiritual impact. I recommend that the entire process of addressing financial issues be bathed in prayer. Include all family members, adjusting explanations if there are young children. This is an opportunity for teaching them Biblical principles of finances and to trust that the Lord will honor His promises: 

     I have been young and now I am old,

     Yet I have not seen the righteous forsaken

     Or his descendants begging bread. Psalm 37: 25, 26 

     For this reason I say to you, do not worry about your life, as to what you will eat; nor for your body, as to what you will put on. For life is more than food, and the body more than clothing… And which of you by worrying can add a single hour to his life’s span?... And do not seek what you will eat and what you will drink, and do not keep worrying… Your Father knows that you need these things. But seek His kingdom, and these things will be added to you…

Luke 12: 22-32 

     Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus. Philippians 4: 6-7 NASB 

     When my husband went on disability, for several months we had family meetings every couple of weeks to share scriptures related to God’s promises of provision, pray, and discuss ideas that would either save money or bring in more income. At the time our youngest child was just starting high school and another was in college. We needed to both tighten our belts and work extra hours. After a year, the Lord opened a job for me that was full time and included health insurance for all family members.

     Be prepared to think outside the box and watch the Lord provide in unexpected ways. Cultivate an attitude of gratefulness, and continue to contribute financially to the work of the Lord. 

     “…Bring the whole tithe into the storehouse, so that there may be food in my house, and test Me now in this,” says the LORD of hosts, “if I will not open for you a blessing until it overflows…” Malachi 3:10 NASB 1995   

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Finances and Chronic Illness

Finances and Chronic Illness

Wednesday, November 15, 2023

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 CHRONIC ILLNESS AND FINANCES

By Gail K. Kachnycz; 05 March 2021; revised 20 September 2023

 “And a woman having an issue of blood twelve years, which had spent all her living upon physicians, neither could be healed of any, came behind him, and touched the border of his garment: and immediately her issue of blood staunched.” Luke 8: 43, 44 KJV

      The full story of this woman’s healing is documented by Luke, a physician himself, in detail in verses 43-48 of Chapter 8. The King James Version notes that she had spent her life’s savings on physicians to no avail.

     Chronic illness is expensive. Copays for prescriptions, the many doctor appointments and out-of-pocket payment for medical equipment not covered by insurance will drain an account in no time. There may be a need to build a ramp or a first floor bathroom to accommodate the limitations of the person who is ill. If the person with chronic illness is the bread-winner, the family income may be severely reduced if progression of the disease means employment is no longer possible. To add to the burden, loss of a job may mean loss of health insurance for someone who desperately needs it.

     The paragraph above describes the worst case scenario. However, the person with chronic illness and the care giver should be aware that finances will need to be reviewed and plans made to economize. Even without chronic illness, every person should aim to live within their means. A good resource is Dave Ramsey’s Seven Baby Steps (www.daveramsey.com/services/financial)

     Every situation is unique. Depending on what kind of treatment or support the ill person needs, it may not be realistic for the spouse/care giver to look for additional employment. Thinking outside the box may be necessary to find new sources of income. Online classes or working from home may be an option. Every social or government program should be checked to see if the disabled person qualifies.

     At a minimum, the information regarding bank accounts, online automatic payments, and credit cards should be available using a secure but accessible method. Include account numbers and passwords. Answers to security questions may be phrased in such a way so that only appropriate people know them. Couples have different approaches to handling finances. One partner may be more detail oriented or have an approach that works well, but both should review finances together from time to time, perhaps as tax season rolls around. If the person with chronic illness is becoming more physically or mentally impaired, designate a financial Power of Attorney (POA). This may not necessarily be the caregiver. The POA can manage the finances and sign paperwork if the affected person cannot attend a meeting. There are Public Notaries who are “mobile” and can provide notary services in the home; check for these in your area.

     At all times, whether in good health or not, avoid debt. If income falls, there will not be a burden of payments and interest to deal with. This is a good Biblical principle in all circumstances of life.

    “The rich rules over the poor,

     And the borrower becomes the lender’s slave.” Proverbs 22:7

      What should you do if chronic illness is diagnosed while your finances are in a mess? Do not despair. Pray, persevere, and take whatever small steps you can to live within your means and reduce debt.

     “I have been young and now I am old,

     Yet I have not seen the righteous forsaken or his descendants begging bread.” Psalm 37:25

      You may want to share with your inner prayer circle (your Peter, James & John) what your financial needs are and ask for prayer. Look for the Lord to supply and share the answers to encourage your prayer supporters.

 Other resources for financial management according to Biblical principles:

Crown Financial Ministries https://www.crown.org

Book: Debt Free Living by Larry Burkett

 

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Supporting the Family

Supporting the Family

Wednesday, November 8, 2023

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Photo: Gail K. Kachnycz. Triple S Casserole (Sausage, Spinach, Spud). I always send meals in containers that do not have to be returned. People have enough to deal with!

INTRODUCTION

     As the title suggests, this article is aimed at a wider audience than just the person with chronic illness or the caregiver. The supports listed below are just a few that come to mind. The most important way to help is to listen and identify what the family would consider most beneficial.

 

SUPPORTING THE FAMILY: Practical Help for Bereavement or Chronic Illness

By Gail K. Kachnycz; 20 March 2021 

     It is important to spend the time listening and praying with the family that is grieving or dealing with chronic illness before offering help. Especially with chronic illness, the need for support is ongoing and the family may feel it is a burden to request help more than once. Those who commit to providing support must recognize that there will be demands on their time and energy. There will also be unique access to seeing answers to prayer, changes in situations that seem intractable and details of how the Lord was working in the lives of those touched by chronic illness. There will be opportunities to grow in Christian faith and experience the joy of the Lord.

     Here are some guidelines and practical suggestions for supporting families:

1. Let the family set the boundaries of the relationship according to their comfort level. Expect that they will share the deepest burdens only with a small inner circle, and more general needs with the larger fellowship.

2. Be clear with the family about what kind of support you can provide and how often. Supports can be tangible (for example: meals, household chores) or intangible (examples: prayer, visits or phone calls to provide a listening ear). 

SPECIFIC WAYS TO HELP

1. PRAYER

     Prayer is not “just” prayer, it is fighting battles in the spiritual realm. This is meaty, significant prayer, not just “I’m praying for you” in a general way.

     Prayer is Powerful.

     Ask the person or family for specific prayer requests. Make a note of them, pray specifically, and check later for the outcome. Prayers for healing and symptom relief should minister to the person or family at the level they are ready to share or receive. If appropriate, pray briefly with the person at the time of the request to take action and agree together. Pray at greater length privately. Pray especially for protection from discouraging thoughts and despair. Chronic illness is a daily reminder that we live in a fallen world. The enemy, who brought sin into this world, uses this reminder as an opening to attack the ill person and family on a spiritual level, and in their minds and emotions. Powerful prayers are needed to defeat these attacks. 

2. PRACTICAL HELP

     It is customary in some churches to provide meals to a family after a funeral, after a hospitalization, or a more joyful event such as the birth or adoption of a child. The need for this type of help is usually limited as the sick person recovers or the family adjusts. In the case of chronic illness, the person does not recover, and the periods of adjustment may recur at each progressive level of decline in functioning for their loved one. A family dealing with chronic illness may feel uncomfortable asking for help again and again as circumstances change.

     Practical help can take many forms, ranging from providing an occasional meal or a once a year yard clean-up, to a weekly day of physical care or respite weekends on a regular basis. The guiding principle is to listen to the person or family/caregiver, and find out what would be the most helpful to them. If you have been praying for them and asking for specific prayer needs, they may feel more comfortable sharing areas in their situation where assistance is needed. The support person should also determine how much time or resources they are able to provide, and communicate this clearly.

     Meals are often the first type of assistance to be offered, since everyone has to eat. Be sure to ask about food allergies and food preferences, so that the meal will be safe and appealing. For example, is anyone allergic to peanuts/tree nuts or wheat? If so, nut breads and pasta are off the menu. Sometimes foods contain allergens that may not be obvious; tahini contains sesame seeds and many Asian foods are cooked in peanut oil. Spicy foods may not be appropriate if treatments are causing nausea or oral sensitivity. To truly be a blessing, the meal should be tailored to the needs of the sick person and family. For information on food allergies, check this link:

https://www.foodallergy.org 

     The family may identify other items or services that would be more helpful to them than food. Mowing the lawn might be an immense help, or doing a day of yard clean-up in the spring or fall, or shoveling snow during the winter. Providing rides to medical appointments or shopping trips may be a priority if the family has no car or the illness has impaired the ability to drive. If the caregiver is still employed, s/he may not be able to get time off for frequent appointments. Even the occasional ride to/from the mechanic when the family car needs state inspection or repair, saves time that would be spent on public transit or waiting at the inspection site. Personal energy can be directed toward care of the loved one instead of the logistics of car maintenance. 

3. SPECIAL SKILLS AND RESOURCES

     The family may be confronting decisions they never planned to encounter. The house may need renovation to install an accessible bathroom or build a ramp to the door. They may need guidance to navigate the details of setting up personal care at home or obtaining durable medical equipment such as a power wheelchair or Hoyer lift device. Legal documents such as Wills, Durable Power of Attorney, and Medical Proxy should be set up.

     If you have a professional license/title or training in the skilled trades, you may want to consider offering consultation or service in your specialty. Be clear if this is a free consultation or paid service. If you do not want to provide direct services, even advice on how to locate the proper professionals can save the family time and help them to obtain the services they need.

Connecting the family to others who have dealt with the same issues can also be helpful. The information from the family with recent experience will be timely and they can share their recommendations about the professional services they used. 

4. SOCIAL/EMOTIONAL

     People are created as social beings. It is embedded in our DNA. This is part of God’s plan for humanity. 

     The LORD God said, “It is not good for the man to be alone. I will make a helper suitable for him.” Genesis 2:18 

     A father of the Fatherless and a judge for the widows,

     Is God in His holy dwelling.

     God makes a home for the lonely; Psalm 68:5-6a NASB 2020

Or, God setteth the solitary in families; Psalm 68:6a KJV 

     The very nature of chronic illness and the demands of caregiving tend to isolate the loved one and their caregiver from other people. Providing social and emotional support is essential. The time and effort invested can range from something as brief as a text of encouragement to the sick loved one, caregiver, or both, to offering a vacation home for several days. Once again, boundaries should be clear and the nature of the support offered should be comfortable for all parties. Here are some suggestions for social/emotional support.

·         Texts of encouragement or sharing scripture.

·         Phone calls; be sure to confirm a convenient time.

·         In person visits; arrange in advance and it is recommended that the visit be brief so as not to tire the person.

·         Cards/letter; these have the advantage that they can be saved & read again.

·         Meals; if providing a meal, consider checking if actually eating the meal together would be welcome. A shorter version would be a brief conversation or visit when bringing the meal; confirm beforehand that this is convenient.

·         Recreation; play card games or board games.

·         Share interests; books, hobbies, etc.

·         Day Trips; can the family be included? Managing the needs of the loved one and planning the logistics of a trip may be daunting to the caregiver. Having the support of a travel buddy to make plans and provide help along the way may bring a trip into the realm of possibilities.

     Reaching out to the family will require thought and intentional action. Providing emotional support is not just another task on the “to do” list. However, if it is not added to the “to do” list or calendar reminders, it remains in the realm of good intentions, which does not provide the support that is needed. As you begin to spend social time with the family, or encouraging them in other ways, this type of support will begin to grow from the heart and fewer “to do” reminders will be necessary. 

5. RESPITE/SELF CARE

     Providing respite requires more time and energy than most of the other types of support. Examples of respite/self care are:

·         “Girls Day Out” (or lunch, etc) for caregivers.

·         Watching the kids (or elderly) so a couple can have a date night.

·         Being “on call” to watch children or elderly if the sick loved one must be taken to the hospital.

·         Providing full care for a day, weekend, or longer so that the caregiver can attend an event or travel away out of town.

     If you are providing respite care and the person requires management of medical equipment, you may need training from the family or the medical office that is managing the person’s care. Sometimes being certified in CPR (Cardio-Pulmonary Resuscitation) will be required. Discuss these types of issues with the family so you will have a full picture of what providing respite will be like.

Photo: 2023; Gail K. Kachnycz. Sometimes a work day for yard clean-up is what is needed.

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Big Rocks for Chronic Illness

Big Rocks for Chronic Illness

Wednesday, November 1, 2023

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Photo: Big Rocks are a familiar sight in my gardening ventures. October 2023 Gail K. Kachnycz

INTRODUCTION:

     A friend sent me the story of the “Big Rocks” in 2001, before Mike was placed on hospice status or the idea of a blog had developed. First of all, I liked the surprise ending (I hope that piqued your interest to check the links for the article and the video!). Second, my life was filled with required tasks, especially when I was working full time during the week and part time on the weekends. Third, I am a champion procrastinator, so I could always find some reason to delay getting to the Big Rocks.

    Important projects usually require extra time and energy and tend to overwhelm me. For me, getting the Big Rocks to fit into my life requires not only identifying what they are, but breaking them down into manageable components and feeling a sense of accomplishment when each is completed. I find this method works best for measurable goals such as decluttering and downsizing a household now that we are headed toward having an empty nest.

     Some of the most important Big Rocks cannot be measured. There is no stack of clean dishes or neatly trimmed lawn to show for the effort. Using the example of the gallon jug and its contents, intangible components look invisible, like bubbles rather than rocks. Like bubbles, they can be squeezed out by other more solid items. Building relationships is a high priority, whether it is with a spouse, children, other family members, friends, mentoring partnership, or outreach to community. Working toward a deeper relationship usually means actually scheduling time together. Thinking that shared experiences will just happen spontaneously means that other mundane tasks can easily fill up the calendar. Even when time together is planned, when the hour arrives, a flare of symptoms may interfere. Mike and I see this happen time and again. If time together needs to be rescheduled, acknowledge that and make a new plan.

                                               Big Rocks are worth the effort. 

BIG ROCKS FOR CHRONIC ILLNESS

By Gail K. Kachnycz on 25 September 2023 (revised from 9 March 2021)

     “Choose Your Big Rocks” is a story related by Stephen Covey in his book First Things First.      This YouTube video is a great demonstration: https://youtu.be/RAzMGtJypsE

     It was also referenced in a post by Christi Barrett on the Humanergy website https://humanergy.com/choose-your-big-rocks/ (Accessed April 3, 2021)

Please read the story or view the video, so you can clearly picture how the lesson of Big Rocks was presented. Humanergy uses the Big Rocks story to illustrate these points:

·         Decide how you want to be remembered [a legacy]

·         Focus strategically

·         Journal your dreams

·         Be goal-oriented 

     Humanergy has a focus on Leadership Development. However, chronic illness may also  bring the idea of leaving a legacy to the fore. What will it be? Family traditions that create strong bonds? Contributions to the excellence of your profession? A family business? A book? Audio recordings of family history?

     What are your Big Rocks? The first step to make room for the big rocks in your life is to identify what they are. This takes thought and careful consideration. It is planned and intentional. Determining the priorities for your life, marriage, or family may require a personal day or weekend spent away from routine demands to get an expanded view of the bigger picture. Some priorities are stated in scripture, such as family relationships and good stewardship. Prayer and Bible study will provide guidance for other issues of importance that are more individualized.

     The Process Hacker (https://theprocesshacker.com) assigns these definitions, which may be helpful to identify what projects or responsibilities require higher levels of attention:

BIG ROCKS: main priorities or long-term goals.

LITTLE ROCKS: day-to-day responsibilities or short-term goals.

SAND: tasks that are not really that important.

WATER: unimportant distractions that prevent you from getting work done. 

     Making the Big Rocks a priority will require time and effort. Those with chronic illness and their caregivers will find that there are demands on their time that cannot be avoided. Examples would be medical appointments or time devoted to medical bills. Illness drains away strength, so energy has to be conserved for the most important activities. Mundane tasks such as cooking, cleaning, laundry, and yard work could fill every minute of the day. Carve out time for the Big Rocks and be sure it is at the time of the day or week when the most energy is available.

     Giving attention to the priorities you have identified will mean deciding how much of your limited time and energy to spend pursuing them. It may mean the lawn is mowed only every 2 weeks, not every week. The house may be a little more dusty or meals from left-overs appear on the table more often. Less time may be spent on screens.

     The effort will be worth it. Like the pebbles, sand and water, the routine tasks of life will get done. Perhaps the dishes sit in the sink for a day, and all the dishes are washed the next day. Perhaps the cardboard for recycling is crushed every other week. It’s really more efficient that way, right?

     However, progress on the important priorities will not happen without planning, perseverance, and “poco a poco” (little by little).

·         Set your priorities with prayer.

·         Plan how to accomplish them.

·         Persevere even when there are obstacles.

·         Poco a poco: break it down into small parts and keep on working on them. 

The Big Rocks are the PURPOSE that God planned for your life. Be sure to fit them in first.   

 

Another video which demonstrates the principle: https://youtu.be/zV3gMTOEWt8

 

 

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