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An American investment banker was at the pier of a small coastal Mexican village when a small boat with just one fisherman docked. Inside the small boat were several large yellowfin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them.
The Mexican replied, “only a little while. The American then asked why didn’t he stay out longer and catch more fish? The Mexican said he had enough to support his family’s immediate needs. The American then asked, “but what do you do with the rest of your time?”
The Mexican fisherman said, “I sleep late, fish a little, play with my children, take siestas with my wife, Maria, stroll into the village each evening where I sip wine, and play guitar with my amigos. I have a full and busy life.” The American scoffed, “I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds, buy a bigger boat. With the proceeds from the bigger boat, you could buy several boats, eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor, eventually opening your own cannery. You would control the product, processing, and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually New York City, where you will run your expanding enterprise.”
The Mexican fisherman asked, “But, how long will this all take?”
To which the American replied, “15 – 20 years.”
“But what then?” Asked the Mexican.
The American laughed and said, “That’s the best part. When the time is right you would announce an IPO and sell your company stock to the public and become very rich, you would make millions!”
“Millions – then what?”
The American said, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take siestas with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos.”
I was honored to again be asked to participate in this year's Engage With Grace blog rally by my friend, Paul Levy, President and CEO of Beth Israel Deaconess Medicial Center in Boston. Thanksgiving is traditionally a time to gather with friends and family...and a perfect time to ask, listen, and learn about loved ones' hopes and desires if they could not speak for themselves. So between the football games, the turkey, and the pumpkin pie...take some time to begin a conversation by sharing Engage with Grace with the important people in your life."Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.
It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.
Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.
A bit of levity.
At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.
To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:
Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.
So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.
Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.
One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.
Wishing you and yours a holiday that’s fulfilling in all the right ways. "
To learn more please go to http://www.blogger.com/www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.
The Longwood Symphony, an orchestra made up of physicians, medical researchers and health care providers, broke with their tradition of playing a large concert and instead took their music to their audience -- their patients. Dr. Lisa Wong, pediatrician and president of the Longwood Symphony Orchestra stated,“To launch this year, instead of having a concert in Jordan Hall, where we usually play for 800 to 1,000 audience members, we thought we’d bring it to the patients". This year the healer musicians were broken into several groups that spread out over Boston, visiting health centers, hospitals and elder care centers in an initiative called LSO on Call: Health and Harmony in the City. They reached a similar number of audience members yesterday, playing for a total of about 800 in nearly two dozen small concerts.
I recently read an interesting article in the Wall Street Journal by Melissa Beck: A New View, After Diagnosis, highlighting a program on "meaning-making" at Memorial Sloan-Kettering for advanced stage cancer patients. The program is based on the seminal work of Viktor Frankl, Man's Search for Meaning, in which he suggests that people can endure any suffering if they know their life has meaning. Dr. William Breithart, who developed the program known as meaning-centered psychotherapy, explains that through the program participants are guided to "reconnect with many sources of meaning in life -- love, work, history, family relationships, and teaches them that when cancer produces an obstacle in one, they can find in one, they can find meaning in another". Results of a pilot study comparing "meaning-making" groups compared to traditional cancer support groups were encouraging in respect to decreased anxiety and increased spiritual well-being.
Is there a difference between empathy and emotional reasoning? Michael LaFerney, PhD, PMHCNS-BC, believes that healthcare professionals often confuse the two, and this can often hinder or derail patient-provider communication. In the current edition of Advance for Nurses, Dr. LaFerney defines empathy "as the ability to understand another person's circumstances, point of view, thoughts and feelings." He goes on to explain that, "Empathy involves communication. Trying to understand what another person is experiencing without communication leads to interpretation without meaning. It becomes a mechanism of internal thought processes rather than an understanding of another's point of view or feelings." Dr. LaFerney describes emotional reasoning as "mind reading" on the part of the healthcare professional; unconsciously inferring one's own feelings, anxiety, or needs to the patient. Emotional reasoning is a lot faster for harried physicians and nurses than empathetic communication, because it does not require slowing down and taking time to truly listen to the patient. But as Dr. LaFerney points out it often leads to misdiagnosis and disconnection from the patient's needs, fears, or desires. The bottom line is MORE COMMUNICATION LEADS TO QUALITY HEALTHCARE.
Dr. Pauline Chen poses an interesting question in her NY Times article, Medicine in the Age of Twitter: Does online social media help or hinder patient-provider communication? If you haven't heard about Twitter, it is a new social media platform that allows users to communicate via short, 140 characters or less, "tweets" to other users. I am intrigued about the possibilities of connection, but am wary of the lack of human touch. What do you think?
Today's New York Times has an interesting article written by Dr. Pauline Chen exploring what we, in the healthcare system, really mean by "patient centered care". Does the definition of patient centered care shift if we are in the role of patient or healthcare professional? In the article, Letting the Patient Call the Shots, Dr. Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Massachusetts, suggests that, “ We would all be far better off if we professionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.” Radical changes in our healthcare system will need to occur to allow this to happen, are we ready for such changes? What do you think?
Cognitive scientists who have conducted research on happiness have found that we are not very good at predicting what will make us happy. Ironically, chronic pain, constant noise can decrease our happiness dramatically and winning the lottery or achieving a life long wish often do not substantially increase our overall happiness. A recent Boston Globe article, Perfectly Happy, explores "happiness research" and its role in guiding priorities for social and health policy.
Thank you to those of you who alerted me to a wonderful documentary series which aired on WBUR in Boston last week. It is beautifully written and produced, an informative view of the dilemma over end of life care in this country. The title of the documentary is Quality of Death, End of Life Care in America: Inside-Out. As I listened to the documentary I felt a more appropriate title might be Quality of Life instead of Quality of Death because even as patients, families and healthcare providers prepare for death, life continues. Perhaps our emphasis on what we DON'T want done at the end of life overshadows what we DO want done? I read an interesting article recently that proposed changing the terminology of D.N.R. (Do Not Resuscitate) to A.N.D. (Allow Natural Death). Is there is a difference in your mind between these two statements, or do you feel it is only semantics? This is difficult topic to wrestle with but one that is growing in prominence in the health care world as we confront a rapidly aging population as well as staggering healthcare costs.