Perception is Not Reality

Here is a little parlor game to play during this Thanksgiving holiday as you are with family and friends -- ask the group to to quickly shout out the color of a traffic yield sign. What did you and the others answer?

If you are like the majority of people I surveyed you said "yellow".  However, yield signs have not been yellow in the U.S. since 1971, they have been red and white for over 40 years! What I found so interesting in this simple test of perception, is that many of those who perceived the yield sign as yellow had not even been born in 1971; thus debunking my theory that only those older than 50 would say "yellow".  So why do we continue to think a yield sign is yellow? Perhaps this illustrates what the Dalai Lama taught me when he visited Boston last month..."just because we perceive it, does not make it reality". How very true!

Take a moment this Thanksgiving and truly step into mindfulness, check out those yield signs, and notice that perception is not necessarily reality.

Haiku Rally #29 The Village

Shortly after Thanksgiving each year basement boxes get carried upstairs and the annual creation of "the village" begins by my daughter, Jen.  Some of these figures were my grandmother's but many are new additions, combined with the older ones to create a magical scene. I love the old and new coming together to create an ever changing landscape!

 The Village
The village appears
Emerging from the boxes
Each year magical

Engage with Grace this Thanksgiving

Each Thanksgiving since 2008 I have donated my blog to an initiative called: Engage with Grace. This year is no exception. There is never the perfect opportunity to talk about end of life issues and it may seem especially incongruous on a holiday set aside for giving thanks, yet why not Thanksgiving? End of life discussions shouldn't be one size fits all or even one time conversations, they should evolve and change as life changes. They are talks from the heart, conversations about the values we hold dear, an opportunity to share our life narrative with our loved ones -- what better time than Thanksgiving weekend to share this gift of listening and sharing? So I invite you to do something a bit unconventional this Thanksgiving, perhaps begin a new tradition, alongside the green bean casserole, share Engage with Grace and let the conversation begin.
Happy Thanksgiving,

Most of us find ourselves pretty fascinating… flipping through photos and slowing down for the ones where we’re included, tweeting our favorite tidbits of information, facebook-ing progress on this or that…

We find other people captivating as well.  In fact, there’s a meme going around on facebook where people share a handful of things that most people don’t know about them – and there’s a great joy in learning these tidbits about the friends and family we think we know so well.
This Thanksgiving, we’re asking our friends and family to try this exercise, but with a twist – we want to know how they’d answer just five questions on their end-of-life preferences.


What? Are you CRAZY? Talk about how you’d want to die over Thanksgiving?  Yup – that’s exactly what we’re suggesting.   You know why?  Because this is a conversation you absolutely want to have exactly when you DON’T need to have it… and it’s a conversation you need to have with your loved ones.   Our hope for you this Thanksgiving is that you’ll have the luxury of checking both those boxes.

As humans, we’re all pretty fascinating, and exploring what matters to each of us under different circumstances can be a captivating conversation…and captivating conversations are part of what turkey dinners are all about.  It’s also a vital one – there will be few times in our lives where ‘getting it right’ is more important than at the end of them.

There are also few greater gifts you can give to your loved ones, and they to you, than making sure these lives we are living with such ferocious intent have the luxury of ending the same way.
Engage with Grace is a way to help get the conversation about end of life started – a way to Engage in this topic with Grace.  Just five simple questions about our end of life preferences that we can all commit to being able to answer – for ourselves, for our loved ones.  Take a quick look – do you know how you would answer?  Could you answer for your loved ones?   There is no wrong answer – It’s only wrong if you don’t know your answers … or if you haven’t shared them.

Coming together over the dinner table to talk about the important stuff is part of our DNA…and it’s where so much of the good stuff happens.  We connect, we share, we learn, we laugh, we fall in love, out of love, we fight and make up, we celebrate, we (maybe even) cry.  If this Thanksgiving turns out not to be your thing, then pick another dinner.  Check out the genius Death over Dinner movement started by our dear friend Michael Hebb to help make that happen.  Thousands of dinners happening across the country – from cool hipsters to the very dearest grandparents coming together to think hard, eat well, and make sure we nail this end of life thing by making sure we’re talking about it.  We double dog dare you to have a Death Dinner – and not enjoy it.

Know what else?  What we want at the end of our lives often changes as we go through them… a mum of toddlers may find she’d opt for more intensive treatment options, while a great-grandfather may feel more comfortable choosing quality of life related treatment… so have this conversation once, then keep having it.

None of us are planning for anything less than living forever – so until one of us is smart enough to make that happen (go Google!) – let’s at least commit to this: we live our life with intent – we can end our life with that same honor.  70% of us want to die at home, only 30% of us do.  Each of us will only die once – make sure you get to die the way you want. Then make sure that’s a gift you give to your loved ones as well.

Just five questions.  Just get started.

Could there be a more important conversation to have this Thanksgiving? Nope. Maybe that’s why they call it talkin’ turkey.

Engage with Grace this Thanksgiving

For the past few years I have joined in the annual Thanksgiving blog rally, Engage with Grace: One Slide Project. This year, however, Engage with Grace holds special meaning and remembrance for me.  

On November 21, our community of Concord, Massachusetts lost an incredible teacher and mentor, David Prifti.  David, a gifted artist who taught photography at Concord-Carlisle High School, had the unique quality of connecting with each student to make them feel like they were the most amazing, talented kid in the world.  But more than that, David taught his students how to navigate life with grace, dignity, hope and humor.  

During the past two and a half years, as David lived with the diagnosis of pancreatic cancer, he allowed us all to become his students as he shared his journey through his widely read blog, Prifti News. Last month he shared with his blog readers his decision to enter hospice care and determine as best he could that the end of his life would be filled with the same beauty, grace and gentleness that had always been central to his life. One of the many gifts that David left with us is the recognition of the importance of communicating with others, expressing our wishes for the end of life.  

And so, this Thanksgiving, I dedicate my participation in Engage with Grace to David Prifti, in gratitude for teaching us all the meaning of grace, hope and peace.  

May your Thanksgiving be filled with mindful moments and shared conversations with those you love.

Engage with Grace 2011: Occupy With Grace

Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day: to ensure that each and every one of us understands, communicates, and has honored their end of life wishes.

Seems almost more fitting than usual this year – the year of making change happen. 2011 gave us the Arab Spring – people on the ground using social media to organize a real political revolution. And now – love it or hate it – it’s the Occupy Wall Street movement that’s got people talking.

Smart people (like our good friend Susannah Fox) have made the point that unlike those political and economic movements, our mission isn’t an issue we need to raise our fists about…it’s an issue we have the luxury of being able to hold hands about.
It’s a mission that’s driven by all the personal stories we’ve heard of people who’ve seen their loved ones suffer unnecessarily at the end of their lives.
It’s driven by that ripping-off-the-band-aid feeling of relief you get when you’ve finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they’d want for themselves, and knowing you could advocate for these wishes if your loved one weren’t able to speak up for themselves.
And it’s driven by knowing that this is a conversation that needs to happen early, and often. One of the greatest gifts you can give the ones you love is making sure you’re all on the same page. In the words of the amazing Atul Gawande – you only die once! Die the way you want. Make sure your loved ones get that same gift. And there is a way to engage in this topic with grace…

Here are the five questions – read them, consider them, answer them (you can securely save your answers the Engage with Grace site,, share your answers with your loved ones. It doesn’t matter what your answers are, it just matters that you know them for yourself, and for your loved ones. And they for you.

We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care -- or C-TAC – working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for our country’s sickest and most vulnerable.

Noted journalist Eleanor Clift gave an amazing talk – finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article. She elegantly sums up (as only she can) the reason that we have this blog rally ever y year:
For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they’re in a crisis, which isn’t the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor’s office.”
It’s a conversation you need to have wherever and whenever you can – and the more people you can rope into it, the better!! Make this conversation a part of your Thanksgiving weekend – there will be a right moment – you just might not realize how right it was until you begin the conversation.

This is a time to be inspired, informed…to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small – yet huge – way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.

Wishing you and yours a happy and healthy holiday season. Let’s Engage with Grace together.

Engaging with Grace this Thanksgiving

As you gather together with family and friends over the Thanksgiving holiday, what are you going to talk about? I am guessing that the topic end of life choices will not be on the list of conversation starters. But perhaps it can and should be. While none of us knows the exact choices we will need to make for ourselves or a loved one at the end of life, we can open an ongoing conversation about what is important for us, what we value, and what are our wishes. As someone who has had to face end of life choices in both my professional life and in my personal life, beginning the conversation around the dining room table is much more compassionate, and empowering than beginning the dialog in the intensive care unit.

For the past three years, I have been participating in the Engage with Grace Blog Rally at the invitation of Paul Levy, CEO and President of Beth Israel Deaconess Hospital in Boston and am thrilled to see that the number of health care bloggers supporting this effort has grown exponentially each year. As we consider the exciting possibilities of participatory medicine and an increased desire for more shared decision making between health care providers and patients/families, we also must recognize that we need to ask about our loved ones wishes for medical care and intervention; understanding that they may not be identical to our own. Please join me and my family as we Engage with Grace this Thanksgiving with one slide and five questions.

With gratitude,

Things we are grateful for this year

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand , communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important – and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.

So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful:

Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go” – it is a work of art, and a must read.

Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.

Thank you to TEDMED for letting us share our story and our vision.

And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.

Engage with Grace: One Slide Project

Happy Wabi-Sabi Thanksgiving

In the November Stress Resources Newsletter, I contrasted the Japanese aesthetic of Wabi-Sabi, the beauty of imperfection, to our westernized view of perfection (think Hallmark card, Norman Rockwell illustration, Martha Stewart anything) continually fueling our stress levels during the holiday season. I asked readers to send in their version of what a wabi-sabi holiday in their home looks like. Thanks to my sister, Hilary Katz Gould, from Huntsville, Alabama, for sending along her thoughts....have a wabi-sabi day, little sis.

Wabi-sabi Thanksgiving table at the Gould's

The pumpkin pie will have a crack in the middle, and the crust will not be flaky or gourmet. It will be made by Sam, and her middle school recipe from 7th grade. Store bought crust and easy canned ingredients. It will be tasty though, and we will only have a few more years of Sam's pumpkin pie to enjoy before college sweeps her away.

Daniela's cranberry sauce will consist of a bag of berries, and a cup of sugar, maybe some orange zest... if we happen to have oranges around. It will end up cooling in what ever bowl is around at the time. May even end up in a plastic cup, if that is the easiest for her 11 year old hands to work with.

Derrick's turkey will be stuffed with a loaf of ripped up white bread with paprika, mushrooms and some chopped onions. His mother's recipe from her Hungarian mother.

None of these dishes will be beautiful, or gourmet, or color coordinated. But, years from now, the picture of the imperfection, or wabi-sabi table will bring back wonderful memories of our family Thanksgiving.

Wishing you all a wabi-sabi Thanksgiving...filled with mindful moments and gratitude.