Tuesday, July 21, 2009

Returning to the poetry of grief

I began a regular series of "diaries" several years ago as a registered member of the DailyKos community, based on linking wire services photos, mostly from the invasion and occupation of Iraq, with poems that I was familiar with, or that I found online.

My idea was to use the words and images to acknowledge and express grief - both as a witness to the grief of others; and as a more direct personal statement about what was happening.

I developed over 600 entries in the DailyKos series, beginning just after the 2004 presidential election and lasting until mid-January, 2007, at which point I developed a blog that continued the series, though with less frequency, for another year.

I haven't done anything else with my project since that time, but thought it would be good to try picking up again here. I'll start by simply copying from that earlier work, at least once each week.

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Cayetana G. Palacios cries as her son, U.S. Army Corporal Eric G. Palacios-Rivera, of Atlantic City, N.J., is posthumously recognized with the Drum Major for Community Service award, during the New Jersey Martin Luther King Jr. Commemorative Commission's annual King Holiday Celebration, Sunday, Jan. 14, 2007, at the War Memorial in Trenton, N.J. Palacios-Rivera was killed in action in Iraq on Nov. 14, 2006. He is pictured on his mother's shirt.
(AP Photo/David Gard)

from Mass for the Day of St. Thomas Didymus

by Denise Levertov

ii Gloria

Praise the wet snow

falling early.

Praise the shadow

my neighbor's chimney casts on the tile roof

even this gray October day that should, they say,

have been golden.


the invisible sun burning beyond

the white cold sky, giving us

light and the chimney's shadow.


god or the gods, the unknown,

that which imagined us, which stays

our hand,

our murderous hand,

and gives us


in the shadow of death,

our daily life,

and the dream still

of goodwill, of peace on earth.


flow and change, night and

the pulse of day.

Saturday, July 11, 2009

Some helpful constructs

Two Paths Through Pines
photograph by Mark A. Kawell

I’ve developed several metaphors that have proven helpful when talking to families facing catastrophic injury/illness and the possibility of death, and who need to understand end of life care in a meaningful context.

To start, let's stop using the awful expression “withdrawing care.” None of us would feel comfortable taking something away from a loved one, especially when that something is literally keeping our loved one alive.

I use the term “redirecting care,” to emphasize our conscious decision to focus on a specific set of objectives – most notably comfort, dignity, and family closeness. This idea also makes better sense when considered in the context of what I describe to families as the three basic paths guiding care in the acute setting.

Curing – The first path focuses on curing the patient’s underlying illness or injury. I use antibiotic therapy and surgery as examples. Often, the patient’s own history includes one or more initial treatments directed at curing, so this is pretty straightforward for most people to understand.

When a patient’s condition is dire, it also helps the family see that the path to a cure may be highly uncertain at best, or even unrealistic, no matter how desperately they may hope otherwise.

Support for Healing – The second path emphasizes actions that support the patient’s own ability to heal. I point to interventions like the nutrition from high calorie/high protein tube feedings, and intubation with mechanical ventilation, as ways that we help a patient get better. I also point out that these measures are generally only needed for a limited time, even if that temporary period extends for weeks.

When a patient hasn’t improved or recovered despite our actions, the family usually finds it easier to understand that the possibility for healing has become more remote.

Comfort and Dignity – The third path is entirely devoted to keeping the patient comfortable in whatever way is required - controling pain, easing air hunger, and calming agitation; and to maintaining the patient’s identity as a person with friends and family who love them.

I also emphasize and identify ways that the family can join in providing this comfort and insuring this dignity.

Families are more at ease when they’re confident we’ll help keep their loved one comfortable, and when they know they’ll all be treated with respect and not left alone.

I’ve found that these three concepts of care support more meaningful discussions with families to determine the most appropriate goals of care. We’re less likely to get into misunderstandings and struggles, and more likely to focus on what we all agree is most important.

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Mark Kawell lives in Minnetonka and Ely, Minnesota…He studied photography, film, art and architecture at Bemidji State College, the University of Minnesota and the Minneapolis College of Art and Design.

Kawell worked for many years as a product and architectural photographer and was an instructor of large format photography at Bemidji State College


During the last decade Mark has devoted more time to his personal photography. He has photographed in England, Holland, Italy, Germany, California, Washington, North Carolina Canada and Minnesota. He works primarily with a 4x5” wood field camera.

Wednesday, July 8, 2009

Vacation soon, then activity

I'm finally putting some things to rest, as I prepare to start some new activities including, I so fervently hope, my plans for developing an end of life care team at work.

I had a couple more discussions with the nurse manager of our unit this past week, and it seems like I'm finally going to soon get the formal go-ahead for the project I first proposed in January, and for which I started preparing last October.

Maybe I've been preparing for this project since I first attended an end of life care program in...2003, maybe. That was a day-long event at Boston's Beth Israel Hospital, now known as Beth Israel Deaconess Medical Center. BI is home to one of the best medical writers around, as well as to a blogging CEO.

Then again, maybe I've been preparing for this project since 1976. That was the year I graduated from a hospital-run school of nursing, and that my father died.

I'll ramp up the frequency of my posting here, and plan to include accounts of the project as well as others related to, or provoked by, the topics of living, dying, death, and the things that precede and follow them.

I've been working on a piece, mostly in my head, about the sudden loss of a colleague last month. I hope to get it down in pixels, in a form that's worthy of the subject, while I'm recharging next week.

Meanwhile, I came across this site while scoping out something entirely unrelated to where I ended up. Ain't that always the way?
Today is the first day after we buried Pablo's physical body in the ground at Forest Lawn. He is now fully and completely at rest. Now we will begin our journey of looking for Pablo's spirit and energy in our lives, in each other, in the world. It's not hard. He cast a wide net, my little Scrapper.

I want to write about the past two days, and I will. But today it's too hard. I can't touch it yet. It's too hot.