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  1. I know it’s happened to all of us at some point during our experience as caregivers: the “self-care” lecture. Eat a vegetable! Take a stroll! Get to the gym, even for fifteen minutes! Get a pedicure! And on, and on, and on… How do these conversations make you feel? I confess that they frustrated me immensely in the earliest days and weeks after my mom’s diagnosis. I was actively offended any time that someone had the audacity to suggest that anything was more important or more time-sensitive than navigating the maze of new information that we were tossed into. I just knew that anyone who could suggest I take time for frivolous activities was way out of touch with reality, and did not understand what I was up against. Worse: I had a feeling in my bones that they did not WANT to try and understand what I was up against. My family’s new normal was in conflict with the suggestor’s point of view on the world where everything was calm and copacetic and pedicures were still a possibility because there wasn’t too much else pressing. Long story short, my friends: I was a wreck anytime someone suggested I take care of myself first. Furious and righteously indignant. One of the most hurtful things I have ever taken to heart (perhaps unfairly, in retrospect) was an extended family member telling me to go get a manicure after I had texted her a photo of a cheap-but-cool new ring I had just bought while running errands. Her words cut me to the core. How dare she? After all, did she not know what was going on? Why did I deserve that amount of downtime, and how would I fit it in if I did, with all the stuff that needed doing? I was so close to saying “well, sure, if you want to fly here and relieve me for a couple hours!” Oh, hold on. Wait a minute. I just looked in a mirror. What’s this I see? I am STILL that person, still feeling those same feelings. They are hard to cast off, even four years after diagnosis, and even with our family somewhat regaining its sea legs and setting sail more confidently into the future than we did when lung cancer was new. I don’t feel this rage or umbrage as often anymore, especially since my parents themselves have been encouraging me to go and do and play and frolic, and I can honestly say I’ve had a few manicures since the “cruel” text. But, to this day, I definitely still build an immediate barrier between myself and any interloper who deigns to tell me to eat healthy and take more walks “because, after all, you can’t pour from an empty vessel.” (Ohhhh how the empty vessel analogy used to boil my blood!) I build the wall because something in my heart tells me that the person who would say those things does not understand me, my family, my parents’ illnesses, my priorities, my choices, or my daily schedule enough to be allowed to weigh in on what I do. Here’s my thinking: no adult is unaware of the need to eat more vegetables and take more strolls and get more sleep. Nobody in their right mind would deny that this is the ideal. But a serious diagnosis upsets every single ideal that a person and their loved ones have embraced and looked forward to. The anticipated and planned future of day to day or year to year fades away, and survival becomes moment to moment. Anyone who has been through it knows this intimately, and I can’t help but doubt the wisdom (not the good intentions, mind you, but the actual wisdom) of those who have not been through this minefield to understand the situation well enough to tell me to eat a vegetable and have it be sagely helpful to my needs. In fact, I recently told a good friend, a fellow caregiver, that “eat better and get more sleep” must have become society’s newest “bless you!,” because I’m hearing it given automatically after telling folks about my situation, just as automatically as they would bless me if I had sneezed. To put things more bluntly: anyone who has not experienced the particular choice of sacrifice for the sake of a loved one’s health/convenience/safety (etc) that a caregiver makes every day has no business telling me what to do, because they have no comprehension of the logistics of my day, and all that must fit inside it, and all the priorities that are NOT me or mine. Don’t get me wrong: I am not advocating for a lack of exercise, sleep, or vegetables. Do I even need to include that disclaimer? I don’t live under a rock and I wasn’t born last night. But that is precisely my point: we must appreciate the intelligence and common sense of caregivers enough to know that such vapid advice does not add information or value to the caregiver’s toolbox. Instead, we as caregivers must encourage more widespread awareness of our situations and all they entail and require, so that people who do have the desire and intention to help can contribute more meaningfully than by speaking platitudes. In other words: I frequently advise extended family and friends of cancer patients to refrain from instructing the caregiver, and to instead LEARN from the caregiver. Don’t tell a caregiver what to do. HELP the caregiver do what he needs to do. If you want him to have time to go fishing or get to the gym, then offer to cook a meal for his family. Better yet, just cook the meal and bring it over, without pressuring the afflicted family to socialize if they do not wish to. If you are trying to support a caregiver, and if you remember nothing else I say here, remember this: try and understand that checking things off the “to-do” list can often be the most satisfying “self-care” that there is. Don’t guilt me for not eating vegetables or not going to the coffee shop when that same thirty minutes could be used to do a chore that’s been bugging me for weeks. Please trust the person actually living in the situation to know what would de-stress the person the most. Do not insert your assumptions. In fact, feel free to ask how you can encourage the caregiver in completing that stressful task. Don’t automatically resort to the incentives system you might use with a child (“hey, let’s get ice cream if you finish that paperwork by noon!”), but ask the caregiver in a meaningful way what support structure he or she needs in order to knock it out (and, hey, it might just be ice cream—the point is to not assume, and not to place yourself in a position of authority). If you are a caregiver, and if you remember nothing else I say here, remember this: encourage those in your life (who honestly want to help) to think of a concrete skill they have or task they could fit into their own busy schedules, and offer them the advice that it would be lovely if they could use that favor as testament to their sincere intent to contribute to the team. Demonstrate that this is the way you could be given the extra thirty minutes in your day for rejuvenation. Empower and enfranchise yourself, caregiver friends: there truly are gems among your networks who want to assist you, but they’ve been given bad information by multiple sources and industries, so they don’t know any better when they suggest that extra piece of broccoli. Nobody is an expert in your situation except you. Nobody is an expert in your loved one’s experience except your loved one. You two should be the instructors, and everyone else in your circles should be the instructed. If I had thought of that earlier, it may have saved me months of anguish and isolation when dealing with friends and extended family members, because I would have broken my assumption that they did not care to “get” it, and I would have filled my toolbox with helpful resources (in the form of helping hands) much more quickly than I did. Come to think of it, I also should have divorced myself long ago from the notion that someone must fully understand my situation before helping me, but that’s a story for another time.
  2. Part 3: Resources One word that is perhaps overused in the professional cancer services field is a word that is also overused in many other humanitarian fields: “resource.” Sometimes, it seems like a catch-all. What do you guys offer? We offer resources! Hm. What does “resource” mean to you? To me, it means something that is drawn from by someone in need of help. Something that is stocked and available to give concrete assistance in a particular situation, and is either infinite in itself, or can be replenished. A replenishable replenisher, if you will! When I see fellow caregivers ask other fellow caregivers “what can I do? How can I help you?,” the answer is always the same. It’s an answer we see every time we ask the #LCCaregiver Twitter chat community the same question: what can your CG family do for you? What is the best way we can be a resource for each other? What can we do for you that is not already being done for you? The answer is so profoundly simple: be there. Listen. Lend a supportive ear. Be a safe space for venting. Sympathize. As much as we all sincerely want to “do more” or “be more” for those who are in our same situation, it seems as though the most important release we can expect from within the “pack” is the one thing we can’t really get from anyone outside the “pack:” understanding. As with any other experience in life, the bond formed when we realize that someone sincerely feels the same way we are feeling in response to the same stimulus is both profound and instant. Only our fellow CGs “get” how we have time to do the shopping and the laundry, but do not have the time to answer the texts or get to the post office (or vice versa), without requiring an accounting of our hours. I swear, my dear non-CG friends and family who may see this, that I know you do not require timesheets from me, but sometimes it feels as if you do. Meanwhile, people who have undertaken a similar journey are not surprised at all when I explain that the day somehow did not actually contain 24 hours as promised on the packaging. As useful (and awesome!) as it would be to live in a place where we could all physically pitch in for our fellow carers (a caregiving co-op of trusted co-carers? Say that five times fast…), it is MORE than enough to lend a shoulder and an “I hear you.” Your support is enough. YOU are enough. Something you have to say could make all the difference in the world for a new or overwhelmed caregiver. So: the number one resource that caregivers have are fellow caregivers. Find them. Reach out. You’re in the right place to start, here on the LCSC: use the Caregivers message board. Use the “LUNGevity Caregivers” Facebook group here: http://www.facebook.com/groups/LungCancerCaregivers/. Come find a buddy in the LifeLine program here: http://www.lungevity.org/for-patients-caregivers/support-services/peer-to-peer-mentoring/lungevity-lifeline. Come to our monthly #LCCaregiver Twitter chats! If you have been doing this a while, find someone who is new to the situation. Someone who needs to be told “it’s okay. I promise. You will find the new normal. It will become routine. I’m here.”
  3. Part 1: Routines Are you a person who likes routines? Or are you a person who likes to play things by ear, deciding in the moment? See: I had always thought I was the latter. I am not the most organized person in the world (sorry, family!), except in those moments when I absolutely have to be. So, it’s always seemed easier to me to make plans on the fly, at the last practicable moment. Or, so I thought. Funny thing about lung cancer: it’s a “canceller.” A what? A canceller. Picture the big, important businessperson of cliché-fame telling her assistant to cancel all her appointments. All her phone calls. Something else has come up. Something bigger. Something that has to be handled NOW. Well, that’s a canceller. Lung cancer is one of them. It’s the feeling you get when you realize you don’t have your wallet. It’s the huge spider that’s headed for your foot that makes you not care that you’re dropping your pile of clean laundry. It’s the face you make when the grocery store is out of the one item you really needed for dinner (seriously. The ONE thing. The thing that made you get up and go to the store. Really?!). Only, worse. Much worse. I’m not saying anything new to you. If you’re here, it’s because lung cancer has reared its ugly head in your life already. I am so sorry for that. I do not mean to dwell in that place. Rather, I want to talk about the thing that happens after the “canceller” throws its wrench in your plans. It turns out, much to my amusement and chagrin, that we…well, we try and find routine. If I’ve said one thing to new caregivers more often than any other thing, it’s: “don’t worry: it’s terrifying now, but eventually it will become routine. No less terrifying, but it will become routine. You’ll find it.” Here’s another phrase I am certain you have heard: “the new normal.” “Our new normal.” “This is our new normal,” “we’re finding our new normal,” etc. See: even in the face of the canceller, we scramble to assemble pieces of routine to create a new façade of having planned at least SOME of what is going on. We crave a normal. And, what else is “normal” if not going about some form of daily grind, fairly certain about at least a majority of the events to happen in any given day? Trust me, I’m the kind of person who never would have thought she found comfort in routine. But, I do. And chances are, you do, too. The very nature of the “canceller” is that it is the event in your day that you never expected, never had written in your planner, and dealing with it requires a tightrope walk between the planned (appointments) and the unplanned (results). Like so many other perspectives and perceptions, becoming a caregiver cruelly removes this inherent ability we all have: to subconsciously rely on routines for safety, while all the while cavalierly denying the need for routine, thinking of it instead as a boring or stuffy way to live. Ohhh how foolish I was! I used to brag about not being a creature of routine: I craved spontaneity and I sought ways to keep the days interesting. I thought that the difference between getting coffee at the same shop in the morning on some days and in the afternoons on other days would save me from ennui. I really thought I had this all figured out. But then, when mom was diagnosed and we were figuring out our new roles and jobs and needs and priorities, I was left aghast at how I was suddenly and sharply yearning to wake up at the same time the next morning and get coffee at the same place and take the same grueling hours to get through my same inbox. I didn’t want to deal with oncology appointments and scan schedules and treatment research and insurance verifications. Who does? That grass on the other side was urgently bright green, and all I wanted was the down-to-the-minute synchronism of the day before the diagnosis. Who wouldn’t? Our routines are also where we as caregivers tend to notice our sacrifices in the clearest terms. “Okay—I can run these errands today and still get in about three hours of my own paperwork.” “Okay, well, that took longer than expected, and I didn’t have a good dinner planned, and that’s on me, my bad, so, well, I guess I can scrunch up that three hours into one hour and just do my best to get it all done.” “Well, okay. I really didn’t know the kitchen would take that long to clean. I’ll try to get my stuff done tomorrow.” And so on and so forth. It occurs to me to assure you that I am not complaining: I would never. Caregiving is a choice I made, and one I feel blessed to be able to make. I am just trying to give voice to what I have learned is a common but unspoken experience in the journey. The lonely hours I used to begrudge giving to email and other necessary evils are now hours of peace and quiet that I miss. How often, as a caregiver, have you been told to “take care of yourself first?” It’s probably a piece of advice you’ve heard many times, all from well-meaning folks: other experienced caregivers, or perhaps loved ones who are worried about you. I maintain that taking care of yourself is often antithetical to the idea of caregiving, but putting that aside for the moment, notice: so much of what we really want for self-care is actually just a return to routine. Time to get to a salon. Time to take on an organization project at home. Time to bake. Time to knit. Time to do any number of mundane things that got left on the back burner when lung cancer rang the doorbell (out of nowhere. Rude). For me, Sunday afternoons are the times when I am most aware of this juxtaposition. On Sunday afternoons (or, on holiday weekends like last week, Monday afternoons!), I try and take the time to do the small things that sit undone in the busy-ness of business hours: change dead lightbulbs, refill the coffee pod carousel, wind the analog clock. Odds and ends. It is meditative work. It’s repetitive. It’s calming. It needs doing, but I find such joy in doing it. It’s…routine. Routine is a teddy bear that gets taken from us, and we spend much of the process of coping with cancer and caregiving trying to pick the perfect replacement teddy bear. It has to be one we can afford, and it has to be one we can fit in our arms with everything else we must carry.
  4. Part 2: Resets The beauty of the Sunday afternoon chores, in addition to creating a zen moment before winding up for the assaults of phone calls and emails and appointments that can come between 9am Monday and 5pm Friday, is that they serve as a sort of reset. A blessed, welcome reset. Whatever was undone from the week before is still undone (LOL!), but nobody died because of it. The cans of cat food that didn’t get moved from the kitchen counter to the bin in the pantry? Not lethal, it turns out. I didn’t have it in me, Wednesday evening, to move those cans to the bin. I just didn’t. One or two or three of us in this house had had a doctor visit, or there was a pile of paperwork with a deadline, and it was all we could do to three-musketeer (three-stooge?) through that particular endeavor before we collapsed. But, now, it’s Sunday afternoon. Tomorrow is a new start, with a new list of responsibilities and schedules, sure, but for now, I can luxuriate in moving those cans of cat food from this counter to that bin. That’s all that’s required of me in this moment. It’s delicious. It’s delicious, and it’s necessary. I am angry at cancer for so many things, but oddly thankful for this lesson that the small chore in the right time can be a way to wipe a slate clean before moving forward. A way to acknowledge what was done, forgive what wasn’t, laugh about it, and start from zero once again. And, if I try really hard, maybe I’ll even commit to that actual hour of work in the morning, instead of getting it swept off the board. Maybe I’ll be that organized. Maybe I’ll structure the day around what needs to get done, and finish the necessities with verve and focus, and by virtue of that organization I might have several hours to give to one of those back-burner projects. And, if I don’t, that’s okay, too. I will have replaced the light bulbs, and wound the clock, and moved the cat food from the counter to the bin. That’s a lot, and that’s enough.
  5. "Why don't you join us?" "Can you come? Want to go?" "I...hope to?" "I...wish to?" "I'll check my schedule." "I will try..." "I can't. Thanks, though! Maybe next time!" Doesn't this sound like the common Caregiver script? I know it does in our house. Invitations turned down and plans not made. The secret is: Even if I thought I could go to the event, I wouldn't want to. Even when I think the potential plans are logistically possible, I always feel as though I have increased the chances of a setback or emergency just by operation of being absent. It only rains when you leave your umbrella at home. Your phone only rings when it's at the bottom of your bag. Being absent seems to be the antithesis of being helpful, and being a Caregiver at any level of involvement means being helpful, right? Present. Aware. If I am neither present nor aware, how can I be helpful? It cuts straight to the "identity" of "Caregiver." No human can be in two places at once. We all know this. ...But it doesn't mean we don't try it anyway. We teleconference, telecommute, telephone. We Skype and FaceTime into doctor appointments. We do research late at night, elsewhere on the internet and in forums like this one, only to call our loved one's doctor back long-distance the next day to ask more questions. So, in the moments when we are not present in any way, actual or wired, how are we being *helpful* in any way? We make ourselves available even when we aren't actually available, so why would we expect any diminution in our commitment to be totally available in lieu of leisure time? No time is disposable. If anything teaches us the preciousness of time, it's cancer. Brutally and unmistakably. So...what is this "leisure time" you speak of? I do not like to miss my mom's appointments. That's my Caregiver profile. (And we will talk about the insidious nature of competition and advice between and among Caregivers later this year). Basically, every situation is different just as every family dynamic is different. Patients and Caregivers are people. No one approach works easily as well for one person as for anyone else. (This is the same as what the oncologists tell you about treatment, so it only makes sense, I suppose). Because I am the kind of Caregiver who balks at missing appointments, my experience is peppered with unmade plans and unmet deadlines. But every Caregiver at any distance or availability feels the same: the waiting, the walking on eggshells, the wondering, the lack of certainty. It all takes an emotional toll. Don't forget: "toll" means "cost." No Caregiver does what he or she does in order to be called a saint or a martyr. The vast majority of us are not even close to completing the to-do list, and are still way behind on everything, but just doing what we have to do. So: why is it that the support systems in place for the Caregiver always make it seem as though taking breaks is best way to operate? Why are vacations encouraged? "Why don't my well-meaning friends realize how much it hurts when they ask me if I can take time for myself?" The bill has to be paid. The dinner has to be cooked. The Rx has to be filled. These come first. They are time-sensitive, life-sensitive concerns. They aren't the hurdles we have to jump; rather, they are the very track we run on. It seems the spa days and morning walks and movie dates--let alone vacations--become the hurdles. The extra effort. The energy mustered at the end of the day, the end of the list, if at all. It is my personal conviction that "self-care" for a Caregiver is not necessarily feasible. Not to the extent that it is discussed and recommended. It is said that "you can't pour from an empty vessel." But doesn't the vessel take time to refill? And pouring has to happen anyway... It's a weak analogy. It is also said that you can't take care of anyone if you don't take care of yourself first. Like the oxygen masks on the airplane: this is another metaphor you see in the self-care conversation quite frequently. A metaphor that is particularly painful in a lung cancer context. If someone needs the mask more than I do--literally and figuratively--I simply have to give it over first, and secure mine later. This week, on our monthly Twitter chat, we will be discussing the idea of taking care of yourself first. Is self-care possible? Is burnout avoidable? Let's talk! We will also be sharing some of LUNGevity's many resources for Caregivers, such as this: http://www.lungevity.org/support-survivorship/caregiver-resource-center/caregivers-job/caregiver-fatigue. Join us Wednesday (3/1) at 8pm EST on Twitter. Just follow #LCCaregiver to participate! As always, I look forward to learning from you, and to coming together as a community! The topics we will discuss are below. Take a look. Sleep on them. I am excited to hear what you have to say! Love and thanks, Danielle What are some of the challenges you experience as a Caregiver? Many #LCCaregivers don't get the help they need, or they take on more than they are able to handle. Do you? What are some common misconceptions about Caregiving/Caregivers? Looking back, what are some warning signs of #LCCaregiver fatigue/burnout? How can a new #LCCaregiver prevent caregiver fatigue/burnout? What advice can you share that may help lessen the burden of Caregiving? Do you feel you have the time to take breaks? Do you feel the need to take time for yourself? Do you feel guilty when you take time for yourself? Do you feel like less of a Caregiver when taking time for self-care? What do you do for self-care?
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