Avoiding the Pitfalls in CPR/DNR Decision Making

Avoiding the Pitfalls in CPR/DNR Decision Making

Educational Objectives:
Examine the obstacles to good DNR decision making.
Discuss what is CPR and the perceived vs. actual chance for success.
Demonstrate best practices for communicating about CPR.
Consider how the signing of the DNR is just one component of
end-of-life care.

Background:
Older adults and their loved ones are being asked to make difficult end-of-life choices about CPR (cardiopulmonary resuscitation) and its refusal, DNR (do not resuscitate). These decisions are fraught with emotional angst and misinformation. In the past, we only used CPR on patients who were having a heart attack and who might benefit from receiving CPR. Now we use it for everyone, including those in a terminal state, whether it will work or not.

One of the complicating factors is that CPR used to be very simple to understand. Now, the general public doesn’t realize that when the doctor says CPR, she is including medications, intubation and ventilator support. A common misunderstanding occurs when people are given the misleading choice of a “chemical code only.” As nurses and doctors will tell you, if the doctor gives the medicine but doesn’t do the chest compressions to move the blood around, the medicine will not circulate in the body. Without circulation, the medicine can not do its job.

Another factor is that the decision about CPR has inappropriately become an indicator of a person’s complete end-of-life wishes—but the decision about CPR should be only one part of the treatment plan. A patient may want chemotherapy, surgery, radiation therapy or other kinds of aggressive treatments and still may want to be a DNR. Or the person may not want other medical treatments but still want to receive CPR. These are all separate decisions and any combination is possible.

One positive change is that the language of DNR has been modified to “do not attempt resuscitation” (DNAR) or “allow natural death” (AND). Both of these help to clarify the confusion. Do not attempt resuscitation truthfully explains that just because CPR is attempted, doesn’t mean it will work. If you ask healthcare professionals, “How many of you would like to die by CPR?” No one ever, ever raises a hand. What they know, but don’t always share with their patients, is that the chance of CPR working is minimal, sometimes even 0 percent. On television shows like ER, CPR brings the patient back to life about 75 percent of the time (Diem, Lantos and Tulsky 1996), when in real life it only works, at best, 17 percent of the time on healthy patients (Peberdy, et al. 2003). In many real-life situations, the chance of success is zero.

William J. Ehlenbach, MD, lead author of a study of CPR in the elderly, published in the New England Journal of Medicine in 2009, explains, “CPR has the highest likelihood of success when the heart is the reason, as in an ongoing heart attack or a heart rhythm disturbance. If you’re doing well otherwise, CPR will often be successful. But, if you’re in the ICU [intensive care unit] with a serious infection and multiple organ failure, it’s unlikely that CPR will save you” (quote from Gordon 2009; study published by Ehlenbach et al. 2009).

The newest term, allow natural death or AND, is a more gentle way of saying do not resuscitate. Instead of stating what won’t be done for the patient, the doctor is offering to allow the patient a peaceful, natural death and will not attempt resuscitation. Because the CPR/DNR decision is about more than medicine, it frames the dying experience for the patient and the loved ones. For those who are making the CPR/DNR decision, it is important to balance the chances of CPR working and bringing the person back in a good condition with the desire for a good, peaceful and dignified death. This is why healthcare professionals wouldn’t want to die by CPR; there is nothing peaceful or dignified about this type of death.

Case study 1:
Mr. Jackson is a 67 year old gentleman who has end-stage Alzheimer’s, is unable to eat and recently had a feeding tube placed. The patient does not have an advance directive and never told his kids what he would want done and unfortunately, his doctor didn’t ask about his CPR wishes when he was in the early stages of the disease. The physician is now asking, “Would he want CPR?” His adult children have been through a lot over the past years and are overwhelmed by the question. The thoughts running their minds are, “Is it time? Are we giving up? I don’t want to make this choice but I can’t stand watching him suffer any longer. If I make this decision, does that mean I have lost my faith?”

How can the healthcare team help guide the adult children through this decision making process? What are the underlying issues that will make the decision more difficult to make? What statistical information might make the decision easier? What grief support can the healthcare team provide to ease the process?

Discussion – Mr. Jackson:

How can we as aging professionals help those we serve as they struggle with these difficult decisions? One of my roles as a bioethicist is to assist families, like Mr. Jackson’s, who are making the difficult decisions. I am not there to tell the family or healthcare team what to do, but to help those involved to think through the issues so they can make a more informed decision. It is important during these conversations that we keep the patient’s wishes and needs at the forefront.

When working with Mr. Jackson’s son and daughter, I would make sure they are educated about CPR. Hopefully, Mr. Jackson’s doctors will not have eroded the trust and created a confrontational relationship by pushing for the DNR. I would need to be patient as these end-of-life conversations are a process, not a one-time event.

I would make sure Mr. Jackson’s children understand the possible outcomes of CPR. He may survive CPR but never be able to leave the hospital or he may be hooked up to ventilators for the rest of his life. Research has found if CPR is able to bring a patient back to life, the chance of the person going home with good brain function is about 7 percent (Kaldjian, et al. 2009). And in Mr. Jackson’s compromised condition, his chances are even lower. The typical success rate of CPR will depend on the health of the patient, the patient’s age, how quickly the CPR was begun and other medical factors.

Next, I would make sure that the family understood what can happen during CPR. Mr. Jackson may be brought back to life but in a worse condition than before, both mentally and physically. There is a chance of broken ribs, a collapsed lung, damage to the windpipe, and the longer he isn’t able to breathe, the greater the chance for brain damage.

Once the family understands the likely chance of CPR working and what kind of outcomes might be expected, I would then point out that by discussing that by choosing CPR, Mr. Jackson may not have the opportunity for a peaceful and meaningful death experience. I would ask his children, “When your father pictured the last minutes of his life, did he see strangers straddling him on a bed, pushing on his chest, with his family waiting outside his door? Or would your father want his family and friends gathered around his bedside, with words of love being expressed, music being played or prayers being said?” By asking these important questions, I am helping to contextualize the medical choices by explaining what it will be like for their father to experience CPR versus a more peaceful death.

Another common issue I may have to address is to relieve the guilt and angst of those making these difficult decisions. One gift I may be able to give Mr. Jackson’s children is to help them understand that it not really their decision. It is the patient’s decision. I would explain that as the decision makers, they are supposed to consider all that they know about their dad, what he has told them in the past, what his values are, and what would be important to him. Using this information, they should do their best to make the decision they think their father would make.

I would gently ask, “What would your dad be telling us if he were able to understand what has happened? What would your dad say about wanting CPR?” And then I would be quiet and let them sit with the question. In most situations, the family will know the answer but it will be painful for them to verbalize the choice. I would then acknowledge how loving and courageous they are to honor their father’s wishes. No matter what decisions are made, it will be important that this family receive emotional and spiritual support as they struggle with these issues.

Case Study 2:

Mrs. Garcia is an 83 year old woman who has multiple sclerosis. Her advance directive states that she does not want CPR. Her multiple sclerosis has developed to the stage where she has lost the capacity to speak for herself. Her husband is her decision maker and caregiver and he knows her wishes. Last week, Mrs. Garcia suffered a heart attack and is now in the ICU. This morning she coded and was brought back to life by CPR. Her husband has just been called to come to the hospital and was told that his wife survived CPR but her condition is deteriorating. What went wrong? Why wasn’t her DNR honored? What is Mrs. Garcia’s expected outcome after receiving CPR?

Discussion – Mrs. Garcia

What went wrong?

Unfortunately, this scenario happens more often than it should. When Mr. Garcia got the call about his wife, he was shocked and angered. How could this happen?

There are a few possibilities. Some doctors won’t agree to a DNR because of moral opposition and therefore won’t write or respect a DNR. While doctors are allowed to live by their morals and to refuse to participate in acts that go against their values, they are still obligated to let patients know about valid medical options and then let the patient or decision-maker decide. If the doctor is unwilling to do this, then the doctor should help the patient to find another doctor who is willing to talk about the DNR option. If the patient, family or someone from the healthcare team is worried about the patient’s rights being violated, he or she should call for a bioethics consult from the hospital’s bioethics committee.

Another possibility is that the DNR request from her Advance Directive was not transferred onto her hospital chart. If the DNR is not on the chart, it doesn’t exist. Whether you are the patient, the loved one or someone working with the family, make sure you go over the patient’s Advance Directive and other healthcare wishes with the doctor and make sure they are documented.

A final possibility is that medical miscommunication occurred. Perhaps the advance directive wasn’t sent up from the emergency room, the team couldn’t find the DNR, no one took the time to look for it, the on-call physician wasn’t familiar with the patient or numerous other mishaps. As much as the public would like medicine to be perfect, healthcare is significantly flawed and human.

What should happen next?

The first step will be to make sure the DNR order is written immediately. I would hope that apologies would come next. Administration, risk management and other hospital staff will be involved in resolving this situation. This event will be evaluated to determine what caused this medical error and to take steps to make sure it doesn’t happen again. (But it will happen again, but usually not to the same patient.)

Ultimately, the doctor will need to sit down and to talk about where to go from here. Since the CPR was performed, what condition is the patient in? What options are available which would be respectful of Mrs. Garcia’s wishes? Is it time for a hospice referral? The doctor who performed the CPR may not be the best person to handle the situation at this point because of the broken trust. It may be necessary to bring in a different consultant to help bring peace to this situation. It will also be important to address Mr. Garcia’s anger and frustration with the hospital and the healthcare team. He will probably be devastated that his wife’s wishes were not honored and that she is still suffering. Appropriate social services should be brought in to help him with his grief.

Upon evaluation of the event, it appears that it wasn’t that Mrs. Garcia’s wishes weren’t respected, but her wishes were not known (because no one read her advance directive) and the CPR/DNR conversation never occurred. This is also a common problem in healthcare. Many physicians are uncomfortable talking about end-of-life issues. I would hope that healthcare professionals don’t just talk about the medical choice of CPR but would also talk about what kind of life one would want after CPR and what kind of death is desired. The following questions are just as important as, “Do you want CPR?”

Where would the person want to die?
Whom would the person want to be with as he or she dies?
What would bring peace and comfort during the dying process?
For many people, CPR just prolongs the dying process, is this okay?

Conclusion:
The conversation about CPR and other end-of-life decisions is a journey of informing, understanding and helping to support the person who has the difficult choice to make. As professionals, we have to find the courage to walk with our patients as they move through their illness and toward death. As patients and family members, it is important to have these conversations early on and I would encourage everyone to ask for the answers and support you need. If the doctor won’t talk to you, find a doctor who will. And if after talking with the doctor, you realize he won’t respect or support the patient’s wishes, find a doctor who will. Once you have made the decision, write it down and tell others what you would want. Don’t make them guess.

A final thought: I am not saying that people shouldn’t choose to attempt CPR; I just want to make sure patients and their loved ones have the facts about what is CPR, the chance of it working, the kind of condition the person might be in after CPR and the kind of death that is being chosen. Make wise and informed decisions for yourself and for those in your care. Have a kind and respectful day.

Study Questions:
What are the common misunderstandings about CPR?
When talking about DNR, what other issues should be discussed?
What do you think would get in the way of you making a good decision for your loved one?
What decision would you make regarding CPR/DNR and how does that affect how you interact with those you serve?

References
Diem, S. J., J. D. Lantos, and J. A. Tulsky. 1996. Cardiopulmonary resuscitation on television: Miracles and misinformation. New England Journal of Medicine 334 (24): 1578–82.

Ehlenbach, W.J., A.E. Barnato, J.R. Curtis, et al. 2009. Epidemiologic
study of hospital cardiopulmonary resuscitation in the elderly.
New England Journal of Medicine 361 (1): 22–31.

Gordon, S. 2009. CPR Survival Rates for Older People Unchanged.
HealthDay: News for Healthier Living, July 1, 2009.
Kaldjian, L.C., Z.D. Erekson, T.H. Haberle, et al. 2009. Code status discussion and goals of care among hospitalized adults. Journal of
Medical Ethics 35 (6): 338–42.

Peberdy, M.A., W. Kaye, J.P. Ornato, et al. 2003. Cardiopulmonary
resuscitation of adults in the hospital: A report of 14,720 cardiac
arrests from the National Registry of Cardiopulmonary Resuscitation.
Resuscitation 58

Have a kind and respectful day.

If Only Our Pet Could Talk

I think for most pet owners, there are days when we wish we could know what our pet was thinking. This is especially true when it comes to medical decision making. We adopt our pets when they are young and healthy and it doesn’t cross our mind that someday, they might get sick or die. The same thing is true for humans. We want to pretend that we will all live forever.

In my work as a clinical bioethicist, I help families who are struggling to make the right medical and end-of-life decisions for their seriously ill loved ones. I never imagined that I would be having these conversations about my beloved kitty, BooBoo. BooBoo had been living with chronic renal failure for over 9 years. She had outlived every expectation and broken all the records for survival at the vet clinic. This sense of my cat being unstoppable and able to overcome every challenge blinded me to the reality that even a cat, who was a medical miracle, could die.

As her health began to change, certain decisions had to be made. I was lucky because I know how to use one of the tools from my work called the Best Interest Standard. Here is how it works.

Step 1. Ask plenty of questions regarding your pet’s medical condition, treatment options including the option of doing nothing, and the risks and benefits of the different options.

Step 2. Ask quality-of-life questions to understand how your decision will be experienced by your pet.

Step 3. After the decision is made, keep checking in to see how your choice is working. If the decision is not working out, then re-evaluate the situation and make a new decision.

The second step is the step that is often missed. When we ask quality-of-life questions, we are asking what it will feel like for our pet. If your beloved pet has to have surgery, what kind of pain will she be in after the surgery? How long will your pet be in pain? What can be done to make the process easier on your pet?

Here is an example of how I made sure I kept BooBoo’s experience in mind.

The vet said that he could run a special thyroid test to see if she was deficient. It was a simple blood test but before I agreed, I asked, “If she does have a problem with her thyroid, what will you do about it?” The doctor said, “I won’t be able to do anything about it because the medicine that would help her thyroid would harm her kidneys.” So I asked him, “Why put her through the needle stick if it won’t help.” He replied, “Some people just want to know.”

Here is where I had to remind myself that what I might want may not be what is best for my kitty. Sure I would like to know, but I didn’t want to put her through the stress of one more blood test when there was no benefit. When we ask about the risks and benefits we are asking, “What are the good things that could happen from the treatment and what are the bad things that could happen?” This doesn’t mean that we shouldn’t choose the treatment, we just have to be responsible pet owners and to understand there can be bad outcomes.

BooBoo got to a point where she had to have daily sub-cutaneous injections, I had to pill her 5 times a day and her quality of life had deteriorated. The doctor told me that he could put in a feeding tube and I could put all of her fluids and medications down the tube so she her quality of life would improve. No more shoving pills down her mouth or sticking her with a needle. It sounded like a perfect solution. Even though I knew it might not make her live any longer, it would sure improve the quality of her remaining days. So I agreed. Unfortunately, BooBoo had a stroke after the procedure and died a few days later.

Did I make the right decision?

I think I did. I asked lots of questions, thought through my choices and did the best I could. Even though it didn’t turn out right, I have peace of mind knowing I gave her the best quality of life possible. Even when I knew she was dying, instead of leaving her at the vets, I brought her home for the last two days of her life so she could have quality time with me. These were precious moments for both of us. When the end was very near, I returned to the vet so she could have a peaceful end. In life and in death, I did right by her by thinking about her needs first.

For a list of questions you can use when making medical decisions for your pets or your humans, go to the resource page on TheCaregiversPath.com

Have a kind and respectful day.

Viki interviews Anne Bland, author of Breathe on September 18th, 9AM Pacific on blogtalkradio.com/kindethics

Viki interviews Denise Baird Schwartz, MS, RD, FADA, CNSD, Health Care Professional from Los Angeles, California and author of Breathe on September 18, 9AM Pacific on blogtalkradio.com/kindethics

Join me as I interview Denise Baird Schwartz as she discusses her new book Breathe – A True Story of Letting Go of My Parents Gracefully, For I Will See Them Again. Breathe was written and published in the first few months after her mom passed during an unexpected hospitalization. It was written during that raw period, when the most important aspects of your life become clearer. The book is a fast read, but it holds a powerful story that can change your life. It will make you laugh, cry and smile. Breathe is a journey of learning to let go.

Bland is a healthcare professional with over 35 years experience in the hospital setting with a focus on taking care of critically ill patients in the intensive care unit. She wants to help others better understand end of life decisions in the hospital. This understanding comes through open communication prior to an illness between family members and their healthcare providers. Breathe views this period as a part of life that is not a time to deny or dread, but one that can be used to reflect on how you live your life.

The nurturing process is so evident in Breathe. The women in Bland’s life, from her great-grandmother forward, have shaped her life, who she is, how she views life, her faith, and has provided her with an inner peace. Breathe will enhance your journey in life, provide you with clarity for end of life decisions related to advance care planning, and allow you the opportunity to help others. Breathe is about honoring lives well-lived and how these lives have shaped the next generation with a focus on family values, caring for others, and giving back.

Breathe opens the door for a meaningful dialogue between patients, their families, and healthcare providers. The book is about living, loving, and letting go gracefully when the time comes.

The royalty from the sale of the book goes directly for relief and development to eradicate extreme poverty and hunger.

Website: www.breathe-annebland.com
Order online at www.amazon.com, www.barnesandnoble.com, www.xlibris.com
Available in hardback, paperback or eBook
Denise Baird Schwartz, MS, RD, FADA, CNSD, Health Care Professional from Los Angeles, California

YouTube videos enhance the emotion found in Breathe. To access the 2 minute videos Google YouTube.com, put in Breathe Anne Bland.

The 2 videos are “Living, Loving, and Letting Go Gracefully” and “Letting Go”.

Have a kind and respectful day.

Viki interviews Lori La Bey from http://www.seniorlifestyletrends.com and http://www.AlzheimersSpeaks.com on August 30, 9AM Pacific on blogtalkradio.com/kindethics

Viki interviews Lori La Bey from http://www.seniorlifestyletrends.com and http://www.AlzheimersSpeaks.com on August 30, 9AM Pacific on blogtalkradio.com/kindethics

Lori La Bey of Alzheimer’s Speaks and Senior Lifestyle Trends is a driver of Change. She helps families, communities, organizations, and businesses maneuver the turmoil of aging and illness. She has dedicated her life to working with people in transition. Lori has done this by guiding businesses and organizations on how to improve service delivery to enhance relationships with senior consumers and their families. Lori’s mission is to shift society’s negative perception of aging and illness, by getting individuals and businesses to appreciate and embrace the gifts wrapped in every stage of life. She believes by removing the fear, the embarrassment, and the judgment that cripples our relationships; we can enhance our connections with the people we love and care for.

Lori understands Caregiving from the inside out. She lost her Father to brain cancer after a 4 ½ year battle. Her Mother has struggled with Alzheimer’s for 30 years and is now in her end stages of the disease. Today she shares tips and techniques she learned as a Caregiver. Her goal is to help people embrace the person who once was, engage the person before them, and let go; allowing love to flow forward; as the ill and aging surrender to the shell of a body that in prisons them.

Lori owns Alzheimer’s Speaks and Seniors Lifestyle Trends. She was recently featured on FOX News for her cutting edge work with Alzheimer’s disease. Lori is a Speaker, Trainer, Consultant, Spokes Person, Author, and now a self proclaimed Advocate on Steroids for Alzheimer’s disease.

Lori is also writing a book on Alzheimer’s disease which will teach people to:
Remove their fear of Alzheimer’s by helping them identify stress triggers so they can reduce combative behaviors and create remarkable moments. The books working title is called: “Alzheimer’s Speaks -Guiding Caregivers to be Their Very Best! Giving Voice and Enriching Lives – As the Cookie Crumbles.”

You can contact Lori La Bey at any of the following:
Resource Website http://www.AlzheimersSpeaks.com
Blog http://www.AlzheimersSpeaksBlog.com
Business Website Http://www.SeniorLifestyleTrends.com
Email Lori@SeniorLifestyleTrends.com
Lori@AlzheimersSpeaks.com
Phone 651-748-4714 or 800-708-8661

Have a kind and respectful day.

When you are going the wrong way, turn around.

When we are making the decisions for those in our care, it is important to make sure that the decision is still working. You may find that you made the best medical decision you could and then the plan didn’t work. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

You may also need to modify your expectations when things don’t work. Sometimes we are so desperate for the plan to work that we can’t bear to see the truth when the plan fails. You are not helping your loved one by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering. One thing that doctors may want to do is to try a time-limited trial of a proposed treatment option. “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option. After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your loved one in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

Stop! The plan isn’t working as expected.

Sometimes, in spite of our best efforts, the plan we designed for the person in our care, doesn’t work or stops working. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

We may also need to help patients/families modify their expectations when things don’t work. Sometimes people are so desperate for the plan to work that they can’t bear to see the truth when the plan fails. You are not helping your your patient by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering.

One thing you may want to try more often is a time-limited trial of a proposed treatment option. Explain to the family, “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option because it helps the patient/family feel like you are trying but it also gives them a reality check when it doesn’t work. You will want to give them specific symptoms to look for, (that they can understand), so they can see with their own eyes that the plan has failed.

After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your patients in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

When your loved one is incapacitated, who will make his or her decisions?

Who should make the decisions when this person can’t? The answer to this question could be any one of the following:
Person specified on the Advance Directive
Conservator or guardian
Spouse
Significant other/partner
Adult child of patient
Parent
Adult sibling
Relative
Friend
Family
Healthcare team
Administrator of the nursing home (in some states)

While this is a general list, the answer really depends on where you live, what the patient has specified and if the court has gotten involved. Each state calls the decision maker by a different name: surrogate decision maker, agent, proxy or durable power of attorney for healthcare. The laws that determine who should make the decisions also change state by state. For example, the administrator of a nursing home may be allowed to make the decisions in one state, but can’t in a different state.

Another rule that varies is the law that dictates a specific hierarchy of decision makers. A hierarchy means there is a legal order to who will be allowed to make the decisions for someone who has lost capacity. You may need to ask the social worker, the bioethics committee or the legal department at the hospital to help you figure out the appropriate laws in your state.

Here are some tips to consider when choosing your decision maker.
1. Pick someone who will understand what the doctor is saying.
2. Pick someone who knows you well and has listened to what you want.
3. Pick someone who won’t fall apart in a crisis.
4. Pick someone who will do what you have asked, even if it difficult to do.
5. Pick someone who is close by geographically.
6. Write down whom you don’t want to be involved in the decision making.
7. You can pick two or three people to work together as your decision makers.
8. Your spouse, significant other or partner may not be your best choice, and you may want to choose someone else.
9. In the “Other” section of the form, state whom you do and don’t want to be told your medical information.

Have a kind and respectful day.

Patience – Lessons Learned – Viki’s Journey

Patience – Lessons Learned –  KindEthics.com Newsletter

Quote of the Month:

The individual is capable of both great compassion and great indifference. He has it within his means to nourish the former and outgrow the latter.
Norman Cousins

I love when life reminds me of the lessons that I thought I had learned, but then I find out I need a refresher course. This month’s newsletter is about having patience, but not just your average patience, instead good-natured and seeking to understand patience. There are two parts to this story.

The second part first:

Two weeks ago I had to make about 50 phone calls to set up the events for my book tour in July. As I was contacting different groups and reaching out to the community organizations that help those with differing levels of capacity, I was on a roll. Each call was a wonderful opportunity to connect with like-minded people about our common goals. I tend to be a quick person and was enjoying the speed with which I was accomplishing my tasks. Then it happened, I contacted some organizations that focus on helping those who communicate more slowly or differently, and all of a sudden, my world slowed down. The reason being, the people I needed to talk to also suffered from the same issues of communicating differently. What had taken me 10 minutes to accomplish on other calls, now took me 25 minutes.

I had a choice. I could politely excuse myself from the call and just move on to someone else. I could get frustrated or start multi-tasking while I waited for them to say what they needed to say. Or, I could be present, slow myself down, listen differently and be patient. I realized that patience was not about “waiting it out,” but it was about staying connected with an open heart as I remembered I needed to listen differently.

When I did this, I heard amazing things. One gentleman with bipolar disease told me that he hoped others would understand when he said, “I can do it – Until I can’t.” I had never heard this phrase but it was a gift to me because it so clearly explains the needs of someone with a fluctuating mental illness. I had understood the concept as this is exactly what I talk about throughout my book. Keeping people included and empowered, despite their limitations, until those instances when they need us to step in and protect them. But I hadn’t had such an easy way to say it. I am so grateful he shared it with me.

Part 1 of the story:

Back in March, when it was Brain Injury Awareness Month, I was fortunate to connect with a wonderful woman named Tammi Diaz. She suffered a traumatic brain injury when she was hit by a car, but she has overcome her injury, found a new way to be, and is a wonderful advocate for those in her community. I contacted her because I wanted to interview her on my online radio show because I thought it would be great for my listeners to hear first hand from someone who still deals with the effects of a brain injury. When I first spoke with her, I was acutely aware of her slightly slower speech. Not much slower, but just enough to notice. She shared with me her stories about the amazing way she advocates at the state legislature and her passion for improving the public transportation in her community. Coming from a show biz background as a child, I wondered if my listening audience would keep listening once they heard her voice. I realized I might lose some listeners but that was the whole point of the show, to get people to hear from people struggling with brain injuries. (You would have thought that a few weeks later, I would have known that I needed to be patient when I was making all those phone calls. But my own agenda and schedule got in the way. Lesson re-learned.)

I booked her on the show along with the director of the Brain Injury Association in Utah. What a wonderful and inspiring interview. I realized that we don’t hear these types of voices in the media or on television shows. This is a silenced community like so many who struggle with mental illness, dementia, developmental delays etc.

So what is in this message for all of us? I hope that you can remember to slow down and to listen differently when you are talking to someone with a speech or brain disorder. Don’t rush, don’t complete their sentences, don’t get annoyed and don’t think it isn’t worth your time. The gift of understanding that you may receive from someone who experiences the world differently is inspiring. I am so grateful that I got the opportunity to practice what I teach. Each phone call brought a gem of knowledge and a connection with a terrific person. Please role model this kind of behavior for your kids, your colleagues and for others in the public when you can see a store clerk growing impatient with someone with a disability. We can make a difference in the lives of others, by listening with a generous heart and a good-natured attitude.

Have a kind and respectful day.

Caregiver Yoga – Right in your home while you raise money for your school

Interview with Laura Colvin-Brown about Caregiver Yoga and raising money for your school. June 10 at 10AM pacific. www.blogtalkradio.com/kindethics

Take care of your self AND your school! Finally… a way for busy parents and educators to get in a little TLC for themselves, while helping out their favorite school…aaaahhh!

If you are like all the other parents and educators that I know, you don’t have time to visit your local yoga studio: who would watch the kids?! …..but you WISH there were a way. Well, now there is!

How about THIS…. we will send you eight new yoga classes every month… that you can watch and do right from your home computer or laptop ANYTIME… and you can do them as many times as you like! 8 all new gentle flow yoga classes will be sent right to your inbox every month when you subscribe to our service. This is like having a private yoga studio right from your screen… for only $15/ month! ….and the best part? Half of that goes directly to the school or group who sent you here.

Compare this to a yoga studio near you: some charge $15 PER CLASS! This is the easiest, most reasonable way to get your yoga in and help your school out at the same time.

Sign up today to receive 8 full video classes every single month!
www.OnlineYogaFundraiser.com
www.FlagstaffYogaFestival.com

Have a kind and respectful day.

Join Viki at Barnes & Noble, Las Vegas on 6/23 from 4-6pm

Viki Kind, MA is happy to announce she will be giving a free presentation at Barnes & Noble in Las Vegas, NV on Wednesday, June 23rd from 4-6pm.

Viki is the author of The Caregiver’s Path to Compassionate Decision Making: Making Choices for Those Who Can’t.

When:
Wednesday, June 23, 2010, from 4-6 PM
Where:
Barnes & Noble
Best on the Boulevard
3860 Maryland Parkway
Las Vegas, NV 89119
702-734-2900

Viki’s book will be available for purchase and she will be on hand to sign your copy!

Have a kind and respectful day.

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