Live Life Now

This was published in the 5/16/13 edition of the News-Record of Maplewood and South Orange

Love enough people and you’ll end up spending some time in the Emergency Room – supporting them that is, and reassuring them that everything will be okay. My family has managed to avoid several trips to the ER by phoning our very generous Maplewood friend, an Emergency Room Physician, who always agrees to see us in her home when we need her and on one occasion when we were on vacation and my daughter dislocated her elbow, actually talked me through the procedure for re-setting the joint.

This Mother’s Day I found myself sitting with a family member in the Fast Track waiting area in the Saint Barnabas Hospital Emergency Room. Through the thin curtains drawn around our examination area to offer a modicum of privacy, I was able to hear other families’ conversations; a woman phoning her mother and wishing her a happy mother’s day, adult children offering humor and words of encouragement, a patient telling her grown daughter about her plans to take better care of herself.

The nursing staff and doctors were upbeat and friendly, their words laced with comfort, their tone confident and optimistic. On our side of the ER were the milder injuries and illnesses that had positive prognoses. Still, for people like me with a tendency to worry, every Emergency Room visit is fraught with some fear and gives me pause and time to consider the “what ifs.”

Last week I received and email with a list of the top 5 regrets of terminally ill patients. These were compiled by Bonnie Ware, a palliative nurse in her book, Top Five Regrets of the Dying. They were, in order of prevalence:
1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
2. I wish I hadn’t worked so hard.
3. I wish I’d had the courage to express my feelings.
4. I wish I had stayed in touch with my friends.
5. I wish that I had let myself be happier.

Perhaps one of the positive side effects of considering, “what if me or my loved one were seriously ill,” is the recognition of life’s fragility and the need to live life fully so that we won’t be left with feelings of regret and mourning what we could have been or should have done.The greatest regret, according to Ware, is not living life true to one’s self. Every once in a while it is useful to step back and ask, what were my greatest dreams? What have I always wanted to do? How can I still make them happen?

Often we yearn not for the attainment of some goal, but to be involved in the process of something we love. For example, my father was always a history buff, and truth be told he would have liked nothing better than to stand in front of a high school or college history class and share his passion. Unfortunately, that was not to be, for in his own words, “boys from Brooklyn who were good in science became doctors.” Now in his retirement, he does research and lectures at the local history club and other organizations. He has realized his passion and is sharing it with others.

The second of the great regrets is connected to the one of the biggest sacrifices we make for work – namely, cutting back on family time. Finding that balance between work and family can be one of life’s great challenges, but few things are more important in the bigger picture. Finding the time, making the time, carving out time; often we feel helpless to do these things, but perhaps the larger goal is that of “being present” when we are with those we love. Spending three hours with family on the weekend doesn’t mean much if we are checking our email every few minutes, or talking on the phone with a colleague or texting or looking things up on the internet. These days spending quality time means disconnecting from our phones, Ipads and laptops so that we can connect with the people in the room around us.

Next on the list of top regrets is perhaps one of the most difficult; having the courage to express feelings. This applies to both positive and negative feelings. Saying things like, “I love you”, “you hurt me”, “I miss you”, “you’re important to me” or even “I’m angry”, can make us uncomfortable, but holding onto anger, bitterness and pain can easily lead to both unhappiness and to health problems, and not sharing positive feelings often leaves us with unanswered questions like; “did he know I loved him?” “did she know how much I appreciated her?” Finding the words and the courage can be difficult, but even if it comes in the form of a letter or email, sharing feelings is critical. Last year I was at a birthday party for a close friend, and her husband got up to make a speech. He is someone who is always quick with a joke or pithy remark. But in front of this crowd of people, he turned to his wife and declared, “you make me a better man.” It was a very tender moment, and the courage of his statement made a deep impression.

Similarly, staying in touch with friends is an obvious necessity, but it requires sustained effort and is often neglected in the bustle of life, and the final great regret; allowing one’s self to be happy, seems a bit mysterious. According to Ware, many didn’t realize until the end of their lives that happiness is a choice. We can choose to remain steeped in bitterness and focused on what’s wrong with our lives, or we can instead look for reasons to be happy and allow recognition of what is positive in the world around us. It’s interesting that so many came to these realizations at life’s end when clarity of vision tends to bring things into perspective.

You needn’t wait for a trip to the Emergency Room. Be true to yourself, make time for family and friends, share your feelings and let yourself laugh. If we live life now, perhaps we will come to realize the gift in every new day.

Guns and Youth – A Deadly Combination

A version of this column appeared in the 4/21/13 edition on the News-Record of Maplewood and South Orange.

Last week several tragic stories made national headlines. One involved a four year old in Tennessee who found a loaded gun resting on a bed and accidentally shot and killed a woman at a cookout. A second occurred closer to home in Toms River, New Jersey. In this case the victim was a child. While playing in the backyard with a neighborhood friend, a four year old boy shot and killed his six year old playmate. Seeing pictures of the Toms River street where this tragedy unfolded – the quiet, leafy suburban streets not all that different from our own here in South Orange and Maplewood – I felt not only sadness, but worry. Could the same thing happen again? How can we prevent it?

Despite the media attention given to these types of stories, the greatest danger in having guns available to children and adolescents isn’t accidental shootings or even intentional homicides. The statistically overwhelming danger is that our children or young adults will kill themselves. According to the National Institute of Mental Health, suicide is the tenth leading cause of death in our overall population, but it is the third leading case for young people ages 15 to 24. Also, this demographic is more likely than others to use firearms to end their lives. In fact firearms are used in more than half of all suicides, and the availability of firearms in the home is one of the leading risk factors for suicide according to the listed by the National Institute of Mental Health. Here is the latest grim statistic: more than 38,000 people in the United States take their own lives every year. This is more than twice the number of homicides.

The majority of these people suffer from depression. Today almost 7 percent of Americans suffer from major depression and for teens that number can rise above 10 percent. Depression is actually the leading cause of disability for those between the ages of 15 and 44 and mood disorders are pervasive in our society. While it’s not unusual for severely depressed people to have thoughts of ending their lives, and some do take the next step and make suicide attempts, those who use firearms are usually successful. Other methods allow time to reconsider. Unfortunately, with firearms there isn’t time for second thoughts. It’s important to know that interviews with survivors of suicide attempts show that they are almost universally relieved that their efforts failed. Since adolescents and children are more impulsive than adults, they are more likely to act on negative feelings rather than waiting them out or asking for help. That is why every expression of suicidal thinking made by young people has to be taken seriously.

In the recent debates on gun control, much has been said about protecting the public from the mentally ill, but I’d like to see more of the discussion focused on protecting those with mental illness from themselves. Given proper treatment, most severely depressed individuals do recover and go on to lead satisfying lives. Twenty thousand Americans ended their lives with a gun in 2012, and our society can and must do more to lower that number in 2013.

Several years ago one of my children attended a local private school that asked all parents to sign an agreement stating that if there were firearms in the home they would be kept under lock and key. It was also suggested that ammunition be stored separately. We weren’t required to sign the agreement, but the list of those who had signed was available to all parents. Simply asking parents to consider the issue was an important step in raising awareness about the need for gun safety at home. Creative measures like these should be considered in our discussions about keeping our kids safe.

What can we as a local and national community do to protect our vulnerable children, adolescents, and young adults? The gun control debate is complex and fraught with conflict, and as the two sides become more polarized it seems that a compromise is more elusive, but keeping our guns safely locked away from young people should be something on which we can all agree. At least that is my hope.

Bring More Love

This Op-Ed appeared in the 1/31/13 edition of The New Jersey Jewish Standard.

It was no surprise that when my grandmother died, her last words to me were “I love you.” These were her parting words for as long as I could remember. They came right after, “Be well, don’t work too hard, don’t worry about anything,” and “enjoy every minute of your life.” That was the kind of lady my grandmother was; quick to give advice and blessings, praise and kisses. “Whatever you wish for yourself – God should grant you, you should have only nachas.” So of course she would part from me with love on her lips.

Recently, as a clinical social worker, I’ve begun to work with people who are ill and sometimes even dying, and I’ve been surprised by their last words to me. Last year, I became involved in the case of a highly regarded engineer at the pinnacle of his career who was unfortunately stricken with cancer. When I first met him, he was most interested in ascertaining what my role would be in his care, and why exactly I was sitting with him in his living room on that particular winter afternoon. On my second visit, he gave me a hug before I left and thanked me for coming. At our third and final meeting, just a few weeks before his death, his speech was nearly gone and he was bed ridden. Still, before we parted he took my hand and spoke softly the words, “I love you.” These seemed to be among the last words he was able to locate and vocalize.

 Around this same time, I took over a modest case load from a therapist who specialized in eldercare. Many of my new clients struggled with depression related to memory loss or losing their independence. Some I saw on a weekly basis and we developed strong therapeutic relationships. One particular gentleman, whom I’ll call George, was wheelchair bound and showed some signs of dementia right from the start. George had been a fiercely independent man who never married. He was an air force veteran who had worked for the government, enjoyed sports, and loved his large extended family. He had a face that looked like a boxer’s and always had a twinkle in his light blue eyes. After working with him for over a year, his memory had deteriorated as had his physical condition.

On the morning, a few months ago, when George’s mind was surprisingly clear and we were able to discuss his failing health, tears streamed down his face and he told me a story, one stored in some compartment of his mind still accessible. As a child, he had attended a local fair with his aunt and some cousins. There they saw a family with many children, all looking longingly at the rides, too poor to purchase tickets. He said his aunt gave him all of their tickets and told him to give them to the destitute mother for her children. “That was the way I was raised, to always care for others,” he concluded. Before I left that day he asked if he could kiss me and I placed my cheek against his scared face, his gnarled arthritic hand in my own.

Two weeks later George was hospitalized and I visited him for the last time. He looked small and frail but his eyes were still shining. Before I left I took his hand in mine and he said, “I love you.” “I love you too,” I replied and waved goodbye. George passed away about a week later.

Then just yesterday, I went to visit another elderly client, whom I’ll call Anna, who is currently hospitalized. She had led a rather reclusive life, had never married and had no children. Anna had been a journalist, but since retiring rarely left her apartment. Even at the assisted living facility where she resided, Anna never went down to communal meals and spent most of her time in bed, curled up with her furry companion – a noble golden alley cat she’d rescued from the streets of her old neighborhood.

 A few weeks ago Anna took a fall and required complex surgery to repair her fractures. A wisp of a woman, once hospitalize she ate less and less and her body began to waste away. When I entered her hospital room I was shocked by her condition; she twitched and shook and mumbled disconnected words to herself. I called her name and she gave me a half smile. After getting her an extra blanket and after a few futile attempts to get her to eat, I finally just sat down and took her hand. “What can I do for you?” I asked, leaning in close to hear her response.

Anna’s answer was both audible and clear, “Bring more love into the world.”

That was not at all the answer I was expecting. I felt helpless; I wanted to do something practical. After a few minutes I repeated my question, hoping to learn of some action I could take to help her feel more comfortable.

This time she raised her voice slightly as if she was annoyed that I hadn’t understood her the first time. “I said; bring more love into the world!”

Okay, I thought, I understand. In the end – the very bitter, deteriorated, demented, trembling, wasting away, hopeless end; there is only love. Since I have heard it from a Jewish grandmother, from an engineer, from a government worker, and from a journalist I have come to believe it is true. I know not whether these words are being expressed because these people already have one foot in the spiritual realm or if they are simply part of a final realization of what is most important in life or if perhaps both explanations are accurate.  

In honoring the wishes of Anna who remains hospitalized, I share her message with you and urge you to heed her words and “bring more love into the world.” If there is a single method for performing Tikkun Olam and healing everything in our world; then perhaps, just perhaps, this is it.