The importance of a living will

This week's readings were very interesting, although they did bring up a lot of feelings both good and sad.  This week I would like to reiterate what the text said about filling out a Durable Power of Attorney or Living Will.  I feel like this is the most selfless thing you could do in life.  Having a Living Will may release your close family from having to make those difficult decisions, as well as granting you your final wishes.  No one is too young to complete either of these forms.

My uncle (age 51) passed away one year ago, in his passing he did not have either of these in place and furthermore hadn't discussed his wishes with any one.  Being a "young" healthy man there was no reason to have either of these in place right?  Until he became very ill with pneumonia.  He was unable to speak and was being kept alive by machines in the ICU.  A week into the dying process family had a meeting and had to make a very difficult decision.  This raised several issues, most of the family did not want to prolong death and some wanted heroic measures.  Just when the family should be coming together they were being torn apart by this horrible decision looming ahead.  Ultimately they decided to "pull the plug", my uncle had passed with all of his family at his side within 3 hours.

After my diagnosis of Lymphoma, I recalled the difficulty my family had with this huge decision.  I was handed a living will at my first oncology appointment, I held on to it for a couple weeks not wanting to face the fact that what I have could be fatal.  After having many discussions with my husband about what I wanted in death I filled it out.  There is no reason I should leave that decision to my family.  My young kids and husband would be devastated to have to make that decision, and having seen how my mom and dad reacted to my illness I wouldn't want them to make the decision due to the "selfish" nature of parents.  I'm not saying my parents are selfish, rather they would want to keep their child safe and "alive" what ever that meant to them.

Again, I really enjoyed this weeks readings and can't believe how fast this quarter has gone, I would like to encourage all of you reading this to create a living will or fill out a durable power of attorney as we really don't know what may be around the corner.

As Good as it Gets

This week I enjoyed the article "As Good as it Gets".  I have often felt Europeans have the right way of thinking, not only do they enjoy nice pensions they have discounted/free travel!  For the younger generations Europeans are allowed much more time to stay home for child rearing in some countries new moms are able to stay home with their children with pay for up to two years.  This compares to our maximum of 12 weeks with many new moms only getting to take 6 weeks due to the need to get back to work to earn money. 

It was really eye opening to me to hear of the cancer surgery and 32 chemotherapy treatments that Trees had was free of cost to them.  The article also states that it could have cost them $30,000 if they had to pay for it.  The government putting limits on what can be charged for certain items must really limit the cost of items.  For each one of my chemo sessions (two days) my insurance was billed $44,000!

It is awesome to hear how the Dutch people are so willing to support each other.  It seems as if in the US we  are all about only helping ourselves, sometimes even family members are struggling and we won't/can't help them out, never mind helping out strangers.  Again I feel like this article was very informative.  Hopefully the Dutch will be able to continue on in the future in the same manner, since the population like that of the US is aging.

Midlife

Well after reading this week's topics I can't wait for midlife!  In some respects I think I am there.  After my diagnosis of Lymphoma I realized my limitations as noted in the article.  My educational/career goal was to become an ARNP  After my diagnosis I feel that RN is the right place to stop in my education/career goals.  This decision was very hard to make but, given that I would like to spend more time with my family it is the right decision for me and my family.  The changes in appearance in midlife as discussed in the text are not frightening to me either, in fact, when my skin matches my gray hair I won't have to explain to "every" patient why I look so young with gray hair.  By the way, don't ask your nurse how old she is then try to cover the rude/inappropriate question with "Well your skin looks so young, but your hair is white!"

I don't think midlife has to be a crisis and in fact, In the article "Midlife Myths" surveys showed only 10-12% of respondents felt as if they had experienced "midlife crisis".  What they often meant was that a crisis took place during midlife such as: divorce, loss of a job, or serious illness.  The text states the secret to successfully negotiating midlife seems to be ego resilience, a powerful personality resource that enable people to handle midlife changes.  I hope I am one of the lucky participants in life that posses ego resilience! 

I look forward to this time in my life.  I look forward to seeing that all of the work of raising my children has been fruitful (hopefully).  I look forward to new adventures, challenges, and retirement.  As I stated earlier I feel like in some aspects I am already moving on to midlife and I hope I am able to experience this time of my life gracefully and enjoy every moment of it, just like the other times in my life! :)

Domestic violence

I think I say this each week and I really mean it!  This week's reading was awesome and very informative.  I did though find myself really reading and re-reading the domestic violence articles from the instructor's notes and podcast.  I have experienced abuse both as a child and as an adolescent/young adult, I was also witness to my mom "taking a beating".  Fortunately for me my mom was very strong and decided to leave after only 7 months of marriage. I was only 5 at the time and distinctly remember the "Last Fight", after he pointed a shot gun at her head, my mom (all 5feet and 100 pounds of her) got up, grabbed the gun, punched him in the face and knocked him out, we ran to the car and left leaving all of our belongings behind!  I wish someone would have talked to her about domestic violence, or interveened sooner!  Looking back I now realize she had many of the listed warning signs long before I even knew what was going on; saying how clumsy she was she was always "falling and getting a black eye", not communicating with friends, and a lowered self esteem. 

I found the information on "helpguide.org" to be very informational.  The cycle of violence is so true, unfortunately I have experienced this first hand both as a child and a young adult.  I made the choice to leave knowing this is not what I wanted for my life.

Working in OB/GYN one of the questions we ask patients is "Do you feel safe at home?".  When I first started asking patients this, I felt as if I was intruding on their private life.  Now it is second nature and I feel like "If I don't ask, who will?".  I was very surprised at how many "No's" I got.  We support these women by giving them the DVSAS (Domestic Violence and Sexual Assult Services) 24 hour crisis hotline wallet card, we lend a caring non judgemental ear, we encourage them to phone 911, we also will set up a code word so if the patient doesn't want the spouse in the appointment she may use the code word and we will ask him to leave for this part of the exam. 

I loved the Do's and Don'ts and would encourage everyone to live by these items:
DO - Ask if something is wrong, express concern, listen and validate, offer support and support his or her decisions.
DON'T - Wait for him or her to come to you, judge or blame, pressure him or her, give advice, or place conditions on your support.

Now is the time for all of us to step up don't shy away from the warning signs if you see them, offer a kind smile and a warm "Is everything ok?".  I'll bet you might be surprised at the answer!

Adolescents and Sexual Orientation

There were many very important and interesting topics in this week's readings, I chose sexual orientation because of a very heated conversation that I experienced last week at a middle school Halloween dance.  I was very interested to read in the text that 5% of teenage boys and girls identify their sexual orientation as gay or lesbian.  The book also states roughly 15% of teens experience a period of sexual questioning during which they sometimes report emotional and sexual attractions to members of their own sex.

At the middle school monster mash dance last weekend a parent approached one of my friends and started a conversation with "Have you seen all of the 7th graders posting on Facebook that they are gay?"  To which my friend did not answer until she had thought about what she might say.  The response was a simple "No, I haven't".  Knowing my friend identifies herself as lesbian I was very curious to hear how she would ultimately respond.  The discussion was civil but became very emotionally driven.  my friend felt as if the adolescents were posting those things to get attention.  She was worried that these kids were opening doors to being teased, bullied, and taunted.  She has direct experience with the emotions and difficulties that these teens might be faced with in the future.

After reading the text I feel like maybe this is a normal feeling these kids are having, however, I don't feel like Facebook is the proper outlet.

I have a co-worker who has a son and daughter ages 16 and 15 (they are only 10 months apart).  Her 16 year old son came out of the closet about 6 months ago, now her daughter is going through the questioning phase. We discussed how her daughter told her, the daughter said, "Don't worry Mom, I'll probably marry a man and give you grand babies.  But, for now when I see people I don't see guys or girls I see things that attract me." 

I feel like 5% of teens identifying as gay or lesbian may be a skewed number because a lot of teens might try to hide how they feel rather than come out.  They might also be "seeking attention". When they come out may also depend on how accepting the teen feels their family will be.  If a family has a strong parent that is always downgrading or "knocking" gay people the teens may wait longer to come out and try to hide their feelings for a much longer period of time.  In a family where parents are open and receiving of other gay/lesbian people teens may come out and may not feel the need to hide their feelings.

I feel that teens are going through so much in this time of their lives: their brains are growing and changing, they are having hormonal fluctuations, and they are desperately trying to fit in with their peers.  I feel it is my responsibility as a human and a parent to support all teens who may be questioning their sexual orientation, rather than putting them down or tearing them apart.  Life is difficult enough for teens with out the added stress of trying to identify with one sexual orientation or another. 

Abuse

Coming from a home where I had my fair share of step-dads, one of whom was very abusive, I was able to connect with the authors of the text in this section.  Over and over we hear that most abusers have been abused.  In my family this is not the case, when I chose to become a parent my husband and I had discussed what we felt were proper discipline techniques.  I had to work very hard to not become the parent I had known.  In fact, when my coliky daughter was about 1 month old I'd had enough of the crying and I was tired too, I placed her in her car seat in the crib where I knew she was safe, I shut the door and took a "time-out" before I became too agitated or frustrated that I couldn't deal properly.  This was the first of many "Mommy time-outs" I have taken throughout the years.  When my son was about 5 I took one of my now famous "time-outs"  when I came out he was telling my 7 year-old daughter "Mom is ok she just doesn't want to say bad words that's why she's in time-out".  I think my kids adapted to mommy's timeouts very well! :)

I have seen the effects of abuse first hand.  However when it comes to a child you love it seems to hurt more than ever.  Reading through the Effects of Abuse on Children in the text I found these to be some of the effects:  social and emotional development disrution, poor relationships with peers, lower grades in school, lower scores on standardized achievement tests.  The good news is that I have also seen resiliency and repair of some of these issues in my own home.  When my niece came to us at age 9 she was very aggressive, was not passing many of her classes in 4th grade, and had failed the WASL.  Looking back it makes me so sad, but to see the growth she has had in these 4 short years really makes me smile.  She is now in 8th grade getting all A's or B's, last year she passed all of the standardized testing with at least average scores, and she hasn't had an outburst of aggression for a really long time! :)  Through counseling sessions and many discussions at home we have been able to fill her tool box with appropriate tools for the feelings she is having. 

I feel like mental abuse is just as bad as physical abuse even though it doesn't leave physical marks, it leaves lasting emotional marks.  When CPS "checks" on a situation or takes a report it seems they don't take into account the emotional abuse that may be going on in a household.  If a child is fed and clean there is no issue.  As we well know just because a child is fed and clean doesn't mean they are safe.  Many abusers tell their victims that if they tell anyone what is going on they will be "sorry".  I have seen this in my younger niece CPS has had 4 or 5 open cases with her she would never talk about what happened at home, now that she is older she is slowly talking about what had gone on. 

I feel that as a society we need to have good role models in parenting, remember to give support and teach parenting skills to parents who may need help, and we need to absolutely not tolerate any type of abuse.

Medications and our Children

Are we over medicating our children?  Reading the article Medicating Young Minds really brought a light to this subject of Bipolar in children and medications.  I didn't realize children could be diagnosed as Bipolar never mind, could be medicated with the same meds as they give adults.  It is amazing to me that we would give our children medications in an "off-label" use to treat these disorders.  I agree that these disorders are serious and children may need to be treated with medications, but we also need to treat with counseling and/or other non-medicinal modalities.  We are medicating children and we don't know if the drug's side effects may do more harm than non-medicating. 

Why are we medicating minor depression in our adolescents?  Who doesn't have minor depression at some point in middle/high school?  For most people, the breakup of that first "serious" relationship causes minor depression.  If we now treat this depression, does this show these adolescents that we should turn to drugs to treat all of our problems?  Again, I am not saying that there are not cases that will require medications, I am just concerned about the impacts of these medications on young minds.  Not only the physical impacts but the impacts they may have on the emotional brain, and their ability to learn and retain new concepts.

I knew a girl when I was growing up she was about 4 years younger than me.  She was severely depressed, there were many suicide attempts (a few close calls) she even lived in a "half-way" house for the mentally unstable.  There were many medications tried to no avail, living in the half-way house counseling was presented to her.  She underwent intensive counseling, they added one medication and she became a productive citizen.  She became a Physician's Assistant and now helps others to heal.  This is why I believe counseling before medications should be part of the treatment for children, get to the root of the problem before treating it.  Medications need to be tested further before given to our young children.  I am glad that research is still ongoing. :)