A Prayer for Later Years

Happy faced moon- March 18, 2010

A while ago I talked to a young nurse who is now working at the hospital on our unit. We were discussing her co-workers and I mentioned a very capable older nurse who was working on her line.

The young nurse said, “ It isn’t nice working with someone who knows everything and makes sure things are done her way.”

I am about the same age as the older nurse and have worked long enough to know a lot about my job. I wondered if anyone thought my attitude toward less experienced staff was that of a “know-it-all”. Several of my co-workers are the age of my children and it is easy to act like a den mother around them.

Empress of Dirt blogger, Melissa (she inspires me weekly) did a recent post featuring framed quotes which are on her mother’s bathroom walls. (Bathroom walls are a good place to hang things you want to think about. We had a calendar hanging in front of the toilet when I was a child and I learned to count by 7’s just by looking at the numbers every day...)

One of the frames held this prayer which is found in several variations on the internet. Its source is unknown although in some places it is attributed to a 17th century nun in England. I don’t think Catholic nuns were very welcome in England in that century so doubt this is true. Whoever penned these works was very wise. I should hang them above my office desk or opposite the commode so I will think about them every day.

This was my favourite version.

A Prayer for Later Years

Lord, thou knowest better than myself that I am growing older and will soon be old.
Keep me from becoming too talkative, and especially from the unfortunate habit
of thinking that I must say something on every subject and at every opportunity.

Release me from the idea that I must straighten out other peoples' affairs.
With my immense treasure of experience and wisdom,
it seems a pity not to let everybody partake of it.
But thou knowest, Lord, that in the end I will need a few friends.

Keep me from the recital of endless details; give me wings to get to the point.

Grant me the patience to listen to the complaints of others;
help me to endure them with charity. But seal my lips on my own aches and pains --
they increase with the increasing years
and my inclination to recount them is also increasing.

I will not ask thee for improved memory, only for a little more humility and less self-assurance when my own memory doesn't agree with that of others.
Teach me the glorious lesson that occasionally I may be wrong.

Keep me reasonably gentle. I do not have the ambition to become a saint --
it is so hard to live with some of them --
but a harsh old person is one of the devil's masterpieces.

Make me sympathetic without being sentimental, helpful but not bossy.
Let me discover merits where I had not expected them,
and talents in people whom I had not thought to possess any.
And, Lord, give me the grace to tell them so.

Amen

Health Care Musings

I have worked in the Canadian health care system since 1975 and even longer if you count my unpaid hours while training to be a physiotherapist. I presently work in chronic continuing care with patients who are generally the elderly with multiple chronic medical conditions. Most of them have worked, raised families and lived productive and independent lives. I try to remember this when they are confused or unable to help themselves perform the most basic human functions. I like to listen to their stories and laugh at their jokes. I once walked into the room of a lady in her mid-nineties who was struggling to roll over in bed. Her bare legs were waving in the air above her diapered bottom. She told me,

"I feel like a hooker who is not getting paid."

I laughed and she laughed as I helped her get up. I asked her if she wanted to get into her chair and she responded,

"As long as it is not electric!"

The queen of one liners even when confused, she was likely the life of the party in her younger years.

A wheelchair covered with a sheet is stored in an alcove by the stairs. Some creative person with a sense of humour added the facial features seen in the picture above. Perhaps they were trying to intimidate Francine, our favourite in-house ghost.

Very few people leave this unit to go home. Some are too ill to move to a nursing home and will die here. But they receive compassionate and ethical medical care at the end of their lives. Which brings me to my point...

The Canadian health care system is not perfect, nor does it cover everything. Primary health care (family doctors) and hospitalization costs are covered but we pay for dental care, optometry, prescriptions (except for people over 65 years old), medical equipment and other extended health benefits. We have wait lists for non-urgent procedures such as joint replacements and other elective surgery. We do not euthanize the sick and elderly. Some areas of the country are under-serviced, especially more remote and sparsely populated communities. But we do not have to worry about receiving hospital bills which would bankrupt a family. And people can opt out of the system as it is not compulsory to have a health card.

I do not understand the strong resistance to universal health care in America. I have read outrageous claims on forwarded emails and some blogs which have made me angry, particularly those which spread exaggerations and lies about Canada's health care system. Many evangelical religious organizations in particular are zealous in resisting both Obama and his reforms. I wonder how many churches pay insurance and hospital bills for members (or non-members) who are in need? The Old Order Mennonites in Canada opt out of our health care system but their community covers costs when they are hospitalized.

Change is not easy and paradigm shifts can be very stressful. Health care reform is a big undertaking for any government. It will take a creative and unified effort to make a new system work well. And I don't want to receive hate-filled email forwards or see caricatures of Obama looking like Hitler or a monkey, especially from people who call themselves christians.

First of all, I ask you to pray for everyone. Ask God to help and bless them all,
and tell God how thankful you are for each of them. Pray for kings and others in power, so that we may live quiet and peaceful lives as we worship and honor God.
This kind of prayer is good, and it pleases God our Savior.
1 Timothy 2:1-3

Parable of the Forest

Not far from our home is a small 35 hectare woodlot of white pine, sugar maple, beech and red oak trees. The canopy towers high above the forest floor and busy roads and an industrial park line its perimeter. It is easy to walk through the trails in half an hour which makes it perfect for a late afternoon stroll on these short winter days. These old trees have marked time for decades. Carved intials, dates and hearts are engraved in the smooth grey bark of the beeches but many are distorted as trees have grown and stretched the scars. Upright dead trees are full of woodpecker holes while others have fallen and are covered with mosses and fungi. The face of the burled tree above is obscured by leaves in the summer and fall, but greets me at the entrance to the trail in the winter.


I came here Friday after work, my mind replaying the day's events, some of which had been unpleasant. Change is coming again and staff stress is increasing with the uncertainty of inevitable restructuring in the coming weeks. Gossip is rampant and criticism of co-workers and management is heard throughout the day. I wanted to confront some people to tell them a thing or two and was practicing speeches in my head as I started my walk. The forest was completely silent. I didn't hear a bird or squirrel or footstep of another person. The wind was still, the sun was low in the sky and the moon was visible above the trees.


The angry words in my head slowly vanished and the stress of the day dissipated. I had hoped to find some birds and then didn't care if I found nothing but silence. I observed the effects of constant change and stress around me. Trees develop burls to enclose areas of trauma and infestation while they continue to grow upward and strong. The roots and tubers of spring's wildflowers wait in the cold and ice for their brief days of bloom and beauty before they prepare for another winter. Some trails are closed to allow nature to heal an area damaged by man or weather.


I have been reading A. J. Jacobs' book The Year of Living Biblically. The author is a secular Jew, an agnostic by his own label, who endeavored to obey the Bible as literally as possible for a full year. The book is "laugh out loud" funny but is never disrespectful or trivial. I could relate to his difficulties with the command, "Do not go about as a gossiper among your people..." (Leviticus 19:16). He made two observations. Keeping silent was the best way to avoid spewing biblically banned negative language, and the less he vocalized negative thoughts, the fewer negative thoughts were in his mind in the first place.

Tomorrow is Monday and the start of another work week. Change is inevitable and I must continue to grow and be positive in spite of circumstances which are beyond my control. And I must internalize the silence and peace of the forest and learn the lesson of the trees.

Friday Flowers: Tulips for Lungs

March 4, 2009 was The Lung Association’s Tulip Day in Ontario. To celebrate the imminent arrival of spring after a long winter, the association sells tulips to raise money and hope for improved lung health in Ontario. Volunteers sold bunches of tulips at the hospital and I had trouble choosing between yellow, white, red and these orange "grown in Ontario" blooms. They are just starting to open up and will give me a little taste of what will grow in my garden sometime next month.

I have worked with patients suffering from respiratory ailments for much of my career. I used to be involved with the Cystic Fibrosis Clinic at the hospital in the late 1970s when the life expectancy for children born with this disease was much shorter than it is now. Cystic Fibrosis is found in the Old Order Mennonite population in our region and in large families, several children may be affected by it. It is also commonly found in other demographic groups. My brother Philip used to help me with an evening Swim and Gym program for children with CF. They had lots of energy and loved the recreational opportunity.

I worked for over ten years in the Intensive Care Unit doing therapy with people suffering from respiratory failure and a host of other serious illnesses. The majority of lung diseases are secondary to smoking (as well as many other illnesses!) but patients with severe asthma, end-stage pulmonary fibrosis, and fast moving infections also end up in acute care. I am sure that everyone has known someone close to them who has suffered from lung disease. We are becoming more aware of the effects of air pollution on lung health and the anti-smoking message is being heard. Ontario does not allow smoking in any public venue including restaurants and workplaces. In the 1970s, students could smoke during university lectures, smoking was allowed in buses, planes, workplaces, malls, even in hospital wards. Wherever I went I came home smelling of cigarette smoke.

The rehabilitation hospital where I now work has a very successful outpatient Pulmonary Rehab program. Patients are referred from the community and attend education and exercise sessions a few times a week. Graduates of the program can return once a week to use the equipment and meet up with friends they have who also have lung disease. Some people can barely walk into the building as they tote their portable oxygen with them, but soon they are doing laps around the first floor or using the treadmills and other equipment available for strength and aerobic training.

Outpatient programs are being cut from hospital budgets at an alarming rate in Ontario. Because the people are not acutely ill and because they can sometimes access similar services for a fee in the community, hospital administrators balance their budgets by reducing these therapeutic clinics. A person with COPD could join a gym or attend a public pool, but it is more motivating for them to be in an environment with trained professionals and other people with similar conditions.

I bought the tulips in support of the efforts of the Ontario Lung Association and hope they will continue to promote positive change for the lung health of all of us.

Canadian Lung Association
American Lung Association

Clear and Cold, Blue and White

Each work day I walk from the parking lot toward this building. My work place is saturated with natural light and has many windows looking out on the lovely grounds. This week brought more snow followed by clear skies and very cold temperatures. Follow me on my morning commute to this familiar place.


Before I leave, our dog goes for a brief outing to a post in front of the house. The snowbanks are so high he can not find a tree or pole to mark and it is impossible for him to run across the yard as the snow is now deeper than he is. My husband spends time outdoors almost every day to keep the walk and driveway clear of new and drifting snow but it is getting harder to find a place to put it all.


This is the view from my car window as I back out the driveway. It is impossible to see the road because of the high snow banks and we inch out cautiously hoping any approaching vehicle will honk or slow down to let us out.


It is nice to arrive at work in the sunlight. When the clock changes to Daylight Savings Time next month I will be arriving at dawn again until the days lengthen further. Today the sun was climbing over the river that runs below the hospital.

Cloudless winter mornings are cold, -18 C on this day*, but the sun has enough warmth to melt the roof top snow a little, creating icicles on the eaves. We have had enough snow to damage some flatter roofs where icy accumulations have built up. But the snow and blue skies do make a lovely winter picture. The house used to be a residence for female staff in the days when this hospital was a TB sanatorium.


This is the original sanatorium, now just a wing of a much larger health care complex. The first floor window arches are unique and graceful. The old balconies where patients used to sit in all seasons to get sunshine and fresh air are no longer used except by squirrels and birds.

One of my patients has spent most of her stay in bed, curled in a fetal position, resisting any attempts to get her involved in treatment. Today I wheeled her to a bright window overlooking the grounds and she lifted her head showing a flicker of interest in the white world and blue sky. I sat beside her and held her hand as she talked about her home and her life, the sunlight seeming to drawing her out of her shell for a few moments.

These are the best days of winter and the blue skies are appreciated even more when they appear after several days of grey dampness and snowstorms. And with this much snow, we need spring to come slowly with sunshine rather than rain to slowly melt all that white a bit at a time.

* this morning Feb 5th it is -29C at 8 AM... going to plug in the car!

Follow this link for more skies around the world.

Getting Back on Track: Part Three

It has been a while since I posted an update on the progress of my knee rehabilitation. I have learned there is no fast track to recovery and while trying to find one, went backwards instead of forward. Just before Christmas I pushed myself to complete 3 km on the track with the walking poles. My knee became more swollen and painful and I could barely walk for the next several days.

My good friend, who has had many knee surgeries including bilateral knee replacements at the age of 45, encouraged me and wrote,

"I am SO sorry that you have discovered the unwritten rule of ortho recovery -- There Wilt Always Be a Setback."

She continued saying,

"...at our comparatively young age, we're going to swell more than the 70 and 80 year olds. My surgeon warned me about this before the knee replacement surgery -- told me that my 75 year old hospital roommate would heal in 3 months, but I would take 4, just because my healthier bones / skin / tissue would produce more swelling. And he was right."

I had often noticed that people in their fifties had a lot more difficulty achieving joint movement after knee replacement surgery due to swelling and soft tissue inflammation but had never heard any explanation for this observation before.

We use standard knee exercises following knee surgery including preliminary quadriceps contractions, knee extension over a roll and straight leg raises. I was unable to do any of these because my knee was bent at a 20 degree angle and my muscles were far too weak to even contract isometrically. When a joint is contracted, the limb is shortened, other muscles are recruited for walking and a limp is inevitable. This abnormal gait pattern can accelerate further joint damage. My main task was to get the joint fully extended and then to strengthen the muscles to the point where they would work in a normal pattern of movement. I have been seeing a skilled physiotherapist who has been very honest and objective with me. She has given me treatment and exercises which have not been necessarily pleasant, but have produced results. My knee is now within 5 degrees of straight even though I have difficulty holding it, and the swelling is gradually resolving.

I am walking on trails again with my poles. We have had a lot of fresh snowfall this month and I find the soft surface easier to walk on than pavement, that is if I control any unexpected sliding. I have decreased my overall walking and have included water therapy and time on the exercise bike. Tomorrow I am finally returning to work on a modified schedule but will have to pace myself and pay attention to any pain or swelling I may experience. The knee will continue to get a lot better with time, but there is no fast road to recovery, even for a physiotherapist. My exercise routine will require a lifetime commitment of modified aerobic exercise and specific strengthening and mobilizing routines.

Making the Best of the Unexpected

Fall leaves in a puddle...Life in a muddle
Interesting nevertheless!

Life seldom follows one straight path for long. Unexpected circumstances inevitably arise causing us to pause, prioritize and plan an alternative course of action. No one is exempt from this pattern which may be confusing and stressful at the time, but in retrospect often brings positive personal change and growth.

Our plans for November did not go as expected. Two weeks ago today, after having a sore knee that gave out causing two falls within as many days, my knee locked in a painful way. As inconvenient as it was, I was given a splint and crutches and had to wait for an "urgent" orthopaedic consultation. We were to leave at the end of last week for Mexico to attend our daughter's wedding. I saw the surgeon the morning of the day of our departure and had to cancel out at the last minute. My husband and the Becka went on, while my daughter who is a nurse stayed with me in Canada. I had the surgery yesterday and know it was a success. My surgical pain is very minimal compared to the pain of the locked joint. I have to take it easy for two weeks and apply some physiotherapy principles to myself, ones that I have taught to many patients over the years. I wonder how compliant I will be?

View from my kitchen window

November and December have never been my favourite months. While I generally have an optimistic and positive outlook on life, I have noticed that I harbour more brooding thoughts in the late fall and am also more susceptible to illness and injury. In the 1970's the theory of biorhythms was very popular, and while it has not been scientifically proved, there is some circumstantial evidence that we may experience cycles of physiological, emotional and intellectual well being. Seasonal affective disorder is a more accepted theory to describe mood fluctuations related to changes of season. Diminishing light is thought to be the main cause of the condition.

Looking back, I see how busyness and stress contributed to this problem. I should have sought medical attention when the knee started acting up, but I just figured I would be told to go for a course of therapy. Now I am forced to slow down and rest and find I am not as indispensable as I thought. Our bodies do have ways of saying "enough already"!

I am fortunate to have terrific coworkers and an understanding professional leader who are filling the gap for me at work. And I can take these personal lessons back to my patients by being more compassionate and understanding of their problems. My immediate and extended family members have been very supportive too. I miss my walks but am taking pictures out the house and car windows. We have had several snowfalls this week and the sun has been shining fairly often. The Becka and her dad return to Canada this evening and I am sure they will have lots of stories about their time with the family in Mexico. My husband has even been bird watching for me.

Time to pause...plan...prioritize.

For I know the plans I have for you, declares the LORD,
plans to prosper you and not to harm you,
plans to give you hope and a future.
Jeremiah 29:11