Thanksgiving...a day set aside in the United States to cook and feast with friends and family. It's also a day to stop and notice the bounty we are given on a daily basis, but often miss in the cacophony of life's busyness. On this day of gratitude, I invite you to spend a few minutes to binge on this calorie-free smorgasboard of natural beauty and thanks lovingly captured by film maker, Louie Schwartzberg. I promise your heart will be filled with a bit more gratitude by the time you finish watching....Happy Thanksgiving. (click here to view Gratitude by Louie Schwartzberg)

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.

Pulling Back the Bow and Releasing the Arrow

 woman shooting arrow"You are the bows from which your children
as living arrows are sent forth.
The archer sees the mark upon the path of the infinite,
and he bends you with his might
that his arrows may go swift and far.
Let your bending in the archer's hand be for gladness;
For even as he loves the arrow that flies,
so he loves also the bow that is stable." ~Kahlil Gibran 

This excerpt from Kahlil Gibran's On Children, echoes in my mind today.  My daughters are now adults and this month has been one of great happiness, pride, and inevitable change.  Our eldest daughter became engaged to a wonderful man last week and our youngest daughter is embarking on her first teaching position as a second grade teacher in Ohio next week.

I am mindful of the moments of joy and also of the moments of longing for the past, holding tightly to the arrows and resisting their release: the age old parental dilemma. To know when to let go and when to hold on is difficult; it challenges us to relinquish control and embrace vulnerability. And so, it is with a heart filled with pride and gratitude for my daughters, Kim and Jen, that I pull back the bow and release the arrows, watching them soar with strength, beauty and joy into the future.   

Commencement ~ The Journey Continues

Last Sunday marked a milestone in my life.  Thirty-two years after my first university commencement, I again crossed the stage; this time collecting a diploma in recognition of my graduate work at the Tufts University School of Medicine's Pain Research, Education and Policy Program. Perhaps because of the years that have passed since I set out in 1979, this commencement was very poignant for me, filling me with gratitude for all those who have guided,  mentored, and walked beside me over the years; my family, friends, patients, clients, students, teachers, colleagues, neighbors and fellow life travelers.

I was honored to be selected to deliver the commencement address for my program, and I share it here with you, my readers.  I welcome your thoughts and comments on your journey.

May 22, 2011
Tufts University School of Medicine 
Pain Research, Education & Policy Program Commencement Address
by Pamela Katz Ressler, M.S., R.N., HN-BC
To the faculty, administration, fellow graduates, and especially to my wonderful family; I am both incredibly honored and extremely humbled to stand before you today. It has been 32 years since I last wore a cap and gown and I am reminded today of that spring day so long ago in Ann Arbor, Michigan. In 1979, the adventure on which I was embarking appeared so clear and direct, much like Homer’s Odysseus as he set off from Troy enroute to Ithaca. But as with Odysseus, we often find our journeys far more complicated than we ever anticipated…meeting not only with trade winds and gentle seas but also with violent storms and towering waves that can batter us and throw us off course. And so it is for the patients we meet each day in healthcare. They, too, are voyagers on their own Homeric journeys, each filled with unique, authentic stories waiting to be told. It is up to us, in healthcare, to elicit, acknowledge, and honor these stories, to bear witness to their individual journeys and to help them navigate through difficult passages. When we first enter the world of healthcare our mission seems clear and direct – we want to quickly fix what we see as broken, to cure what we see as diseased. While this is a noble mindset, we often miss the opportunity to heal when we blindly set out in this direction. What I have learned is that often we cannot cure, no matter how desperately we try, but the potential for healing is always possible. This statement may seem incongruous to what we see as the measurement of medical success. But, as we look broadly at what healing really is… isn’t it all about reducing pain and suffering…about living and dying with dignity, grace, and a sense of purpose? We meet our patients at many points on their journeys and I see our work as assisting them in gathering the necessary tools of healing to find safe passage on their voyages.

During the course of my studies here at Tufts I have discovered many tools of healing. The Pain Research Education and Policy program was not on my navigational charts when I set off in 1979, but I am so grateful that I found my way here. Through my work with inspirational faculty mentors, especially Dr. Bradshaw, Dr. Glickman-Simon and Dr. Carr, as well as Dr. Gualtieri in the Health Communications program, I have explored pain not only as a physical manifestation of injury or disease, but also as a complex pattern of psychosocial and cultural components that contribute to a sense of suffering. Addressing the suffering has a direct impact on reducing the sensation of pain. The Pain Research, Education and Policy Program has allowed me to explore the intersection of modern medicine, technology, ancient healing practices of the body and mind and spirit, and the innate human desire to survive adversity. It has given me a voice in advocacy and scholarship by helping me to articulate the meaning of pain and suffering for individuals and society. For this I will always be grateful. Some of you may be familiar with the poem, Ithaca, by Constantine Covafy. It is a poem that has kept me company on my journey and I would like to offer it to you as a metaphor for this commencement, as each of us sets forth on new journeys and adventures:

When you set out on your journey to Ithaca,
pray that the road is long,
full of adventure, full of knowledge.

The Lestrygonians and the Cyclops,
the angry Poseidon -- do not fear them:
You will never find such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your spirit and your body.

The Lestrygonians and the Cyclops,
the fierce Poseidon you will never encounter,
if you do not carry them within your soul,
if your soul does not set them up before you.

Pray that the road is long
That the summer mornings are many, when,
with such pleasure, with such joy
you will enter ports seen for the first time;
stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and coral, amber, and ebony,
and sensual perfumes of all kinds,
as many sensual perfumes as you can;
visit many Egyptian cities,
to learn and learn from scholars.

Always keep Ithaca on your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for many years;
and to anchor at the island when you are old,
rich with all you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would have never set out on the road.
She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.
And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing….Thank you and Bon Voyage.

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.