I am a little less than half-way to my 40th birthday. I promised myself that I would look to improve my life as I face a new decade close to a new year. I think that everyday there is a chance to see things differently, choose an action toward joy, and make choices that enhance my life.
I am not sure why all of a sudden I am feeling this so strongly. I think that facing 40 has led me to do some of that life review I do with my dying patients. I have noticed lately, too, that I have been especially impacted by my patients whose demise isn't happening tomorrow; rather, they face a terminal illness and they have 1 month, 3 months, 6 months and they have chosen to accept that path rather than continue fighting…but they feel okay, they may be home bound or chair bound or limited in getting around. I keep thinking that many of these folks will just be so peaceful, just like I would want to be if it were me. But they aren't. One man keeps asking me how he will die because he is just plain afraid. One woman has such severe memory lapses due to her metastasized cancer that she thinks all her friends have taken all her money; in reality her friends are wonderful and supportive and try to help her make the best decisions possible. Another man's young adult daughter just got engaged and he wants to walk her down the aisle in 3 months. He won't even consider a smaller gathering soon because he wants to be a part of the big gathering this summer; unfortunately, we all know he probably won't be here for her wedding day.
I am not trying to depress the mood; I suppose I am trying to find reasons to justify why I am attempting happiness every day. Because, I look into these people's faces and I see people who, even at the end of life they struggle finding joy "in the moment", which, when it comes down to it, is all we really have, whether we are healthy or sick, facing death or starting life. Maybe turning 40, I feel a little more mortal, a little more vulnerable, and a little less ego-driven. Maybe I feel like life is too mysterious to miss, getting caught up in day-to-day transgressions and daily annoyances.
I often elude to my job but don't write about it much. I suppose I feel a little embarrassed that I dislike all the things that make hospice work hospice work. The unpredictability, the family dynamics, being on call, that darn phone that bings and rings all day that I must attend to. But there are things about it I love. The family who really wants to understand end of life care for their loved one and asks thoughtful questions; the special volunteers who sing songs to dying patients or make meals for a homebound patient to have something other than soup. The patient who is realizing her fate and just sits with me for an hour, in silence, letting the tears run down her cheeks. My amazing team-mates who just pick up where we all leave off with little to no explanation and run with it.
In the pros and cons lies boundary issues and burnout. I always verge on the edge of burnout because the nature of this business relies on strong self-care and good boundaries, which I admit I must tend to on a daily basis or I can run off the rails pretty fast. So, starting January 1st, the rule of thumb I have implemented is "put myself first." In life. At work, at home, with friends and family. That small rule of thumb has helped me get to that family meltdown in time to negotiate a plan; has helped me stay strong when I have to stand up for an elderly patient's rights to family members who think it is okay to leave a bed bound 91 year old who is hard of hearing, has extreme anxiety of being alone and has no way of calling out locked up in her apartment on the 12th floor of a very large building…(Okay, breathe Melanie, breathe)…or when a team member attempts to make her emergency my emergency when, in reality, it really isn't an emergency (this is hospice, people, not the ER…come on!).
What does "putting myself first" mean? It means I get up a smidge earlier, drink coffee in bed and read on my Kindle before walking Rene without taking my work phone with me in the morning. It means setting my first appointment at 10 and my last one at 2 so I can check email and do administrative stuff during the actual 8 hour work period and not extend beyond that. It means saying no…if someone isn't dying then no, I may not be able to get there right now because I have 4 other people to see…how about tomorrow? It means letting calls go to voicemail because if it is urgent I will get an email anyway. It means packing my lunch, drinking plenty of water, keeping my car gassed up, and giving myself comp time when I am on call.
I told a good friend, who just retired after 30 years at one organization where she dedicated much of her time to working and being on call, about my "put myself first" plan at work. She was skeptical. "But Melanie", she said, 'They are paying you to work there." So, let me put to rest that my "put myself first" idea has nothing to do with me hanging out at the mall while I tell my employer I am working. It just simply means that in order to do well at my life, I need to make sure all my needs are met first. Once they are, then I can worry about you (think airplane oxygen mask).
And it is working! I don't complain to mom so much anymore over the phone. I start my day and end it usually in an 8 hour time frame. Rene and I walk two times a day-no skimping. I am reading two books. I no longer have the sugar/junk food crash I would experience after "grabbing lunch out" while on the road. Sure, I have my moments. I still hate being on call. I still tense up when I get an urgent needs message, or see the admission email about the new patient whose family can't caregive for her and they have no money and oh, by the way, watch out for drug diversion. I still lose sleep over some cases, or dream about others. Self-care and boundaries, like I said before, are effective only if tended to day-to-day. As long as I do that, I will be okay.
