Every Note Played

I am a commuter these footloose and fancy free days.  Yes, that’s sarcasm.  Care giving rides with me all the time.  It knows when I’ve been sleeping, it knows when I’m awake, it knows that I’m trending badly and never good enough… Whee!  Everybody sing!

Still, the time in the car lets me enjoy reading, by which I mean listening to audio books.

Every Note PlayedI just finished Every Note Played by Lisa Genova.

This simultaneously brutal and beautiful novel is primarily a call to compassion for those suffering with ALS, commonly called Lou Gehrig’s Disease.

It’s also an honest and sympathetic portrayal of care giving.

The story follows world renowned concert pianist Richard as the disease takes control of his life.

At the same time, it gives voice to his decidedly estranged ex-wife Karina.  As the disease progresses, it falls to her to become his primary care giver.

The fictional Karina will become an immediate confidant to any real life care giver who reads or hears the story.  Like most of us, care giving falls in on her.  Her life is taken over by ALS, too.

The author brings out the full range of care giving emotion.  There are all of the bitter, ugly feelings and daydreams.  There are also the splendid discoveries and inner healings that would never come without the demand to take care of another in ways above and beyond “normal.”  There’s painful honesty about playing the victim and blaming others or an out-of-our-control illness for life choices we did have and failed to make – or made poorly.

The story also brings in the perspectives and significance of others called upon to care for Richard; there’s Bill, a home therapist who found his calling by caring for a partner with AIDS; Grace, Richard’s and Karina’s collegiate daughter who must slog through the fallout of their divorce to reconnect with her father; and an array of medical and therapeutic specialists whom the author imbues with distinct personalities and gifts that they bring to bear as Richard’s need escalates.

Genova does noble work in articulating, through Richard, the point of view of the person receiving care.  There’s the flood of gratitude for what seem like minor gestures, and the cold indifference or flaming hostility to big ticket technology that can add convenience but deepen feelings of imprisonment and humiliation.  There’s the need for power to make some choices, from the right music to play to life and death decisions about treatment options.

By exploring Richard the caree and Karina the primary care giver with depth and honesty, the story makes their struggle to be at peace credible, dramatic and moving.  If your tear ducts still work, they will find opportunity to represent as this story unfolds.

My minor quibble with the book derives from its core strength.  It is a detailed explanation of ALS in story form, but the quest to get in all the info about the disease sometimes overflows the narrative and comes out like a lecture.  A chapter that mentions a palliative drug cocktail lists the specific medications at least three times by name.  There’s an infrequent but noticeable tendency to wander away from expressing the disease through what Richard is experiencing, thinking and feeling to sentences that seem disembodied and didactic.  The info is worthwhile, to be sure, but sometimes intrudes on the connection with the characters that is the heart of the book.

But taken as a whole it is an excellent novel.  It is a story in which the heroes are the villains and vice versa.  Richard and Karina are each, as Charles Lamb said of Coleridge, An Archangel a little damaged.  Although their story is driven by ALS, their struggle will ring true for family caregivers in any setting.

Dress Rehearsal

With our son’s new life in a group home comes our reclaimed freedom to have company without having to provide tag team care giving.

In recent weeks we’ve welcomed an eclectic group of friends to come over for a Friday night Bible study.  We look into topics brainstormed by the group.

Last night we looked into death.

As you might imagine, that took us in a number of directions.  One point that seemed to resonate was that life is full of dress rehearsals for death.  We suffer losses, not only of people we love but also of dreams, relationships, health, money, fantasies and you-name-it.

Nothing is held permanently and nothing is 100% under our control – As he came from his mother’s womb he shall go again, naked as he came, and shall take nothing for his toil, which he may carry away in his hand.  (Ecclesiastes 5:15)  That death-like denuding goes on all the time, in the midst of life.

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Jared Cole photo from here.

 

For caregivers, it happens with a vengeance when we hear the diagnosis that turns us into, well, caregivers.  An envisioned future with a loved one dies and we die to the life we were living to that point.  The call to care giving is a blaring trumpet, announcing a cavalcade of casualties.

The Christian spiritual path is one that takes in such deaths as part of life, as dress rehearsals for the physical death that is the lot of all living beings.  I die every day!, flamed the Apostle Paul.  Yet he affirmed that this was not the final word, but always a preparation for a new and unexpected life to flower, 

You foolish person! What you sow does not come to life unless it dies.  And what you sow is not the body that is to be, but a bare kernel… (1 Corinthians 15:36)

And we can find that the dress rehearsals – those death-like losses life brings – can connect us to a death enacted for us, to empower and transform us in the here and now, not to endure losses with a stuff upper lip or daydream about a heavenly pie in the sky,  but to become life-giving blessings to those in our care; indeed to the whole creation,

I have been crucified with Christ. It is no longer I who live, but Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me.  (Galatians 2:20)

Let me say it again: the Christian life isn’t stiff upper lip or pie in the sky but, as one of our friends pointed out last night, passionate commitment to life with all its hurts

When Jesus saw her weeping, and the Jews who had come with her also weeping, he was deeply moved in his spirit and greatly troubled. And he said, “Where have you laid him?” They said to him, “Lord, come and see.” Jesus wept.  (John 11:33-35)

and a divine gift to help us move the world with love,

I tell you the truth, anyone who believes in me will do the same works I have done, and even greater works, because I am going to be with the Father.  (John 14:12)

Entertain the thought that care giving is one of these greater works that Jesus promises to load with heavenly power.

And keep rehearsing, even through the death scenes.

Who cares for prisoners’ carees?

A friend who visits prisoners shared this piece that crosses into both of our areas of concern.

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A view of the South Dakota State Penitentiary, Sioux Falls

Care giving tends to be accepted rather than sought out.  It lands on many of us more like a meteor than like Santa sliding gently down the chimney with gifts.

Spouses, grandparents, foster families and others care for the dependents of people in prison.  They accept difficulties that none of us would choose:

FINANCIAL IMPACT OF INCARCERATION ON CAREGIVERS

Financial problems are extremely common for caregivers. Consider these key factors:

  • Family income averaged over the years a father is incarcerated is 22 percent lower than family income was prior to the father’s incarceration. (Western and Petit)

  • Seventy percent of children’s caretakers are over the age of 50. About 55 percent of children live with a caregiver who doesn’t have a spouse. And 19 percent live in households with four or more children living there as well. (Hairston)

  • Caregivers may have to make the decision to leave their jobs in order to take better care of the children. Those caregivers who are no longer working often exhaust their retirement savings in order to pay for the children’s needs. (La Vigne)

  • Forty-one percent of children in kinship care live with families with incomes less than 100 percent of the federal poverty level. (Hairston)

Prison Fellowship and others have creative programs aimed at supporting the care givers outside of the walls.

Care givers are easily overlooked as it is.  The shaming and marginalization of those with a loved one in prison can only add to invisibility.

One of those days…

…on which I woke up at a mellow pace, had a fruitful time in prayer, went to the gym, and am now brewing some coffee with little on the agenda until a friend’s graduation party this afternoon.

In other words, the kind of dawning weekend most folks desire, but which is too often eclipsed.  This is especially true over the years of care giving.  Weekends?  Holidays?  Vacations?  HAHAHAHAHAHAHAHAHA

20180515_123848I read a novel for a library book club (yes, I can go to things like that if so inclined these days).  The title evokes some of my perception.  Care giving calls on us to bury a good chunk of life, especially our many preferences if we are true to the task.

Aspects of who I am are being excavated these days.  It’s uncomfortable rediscovering them.  Was I lazy or a failure to have let them get buried?  Shouldn’t I have kept life in better balance?

Or are such burials loving sacrifices?

These and questions like them exercise my heart today.  I am thankful that I have the time and space to ponder them.

 

We’re being followed

Here’s a bit from Raising a Child With Autism, courtesy of the publisher,

I was more on top of weed-pulling in our first garden. I had the energy of youth, the pride of a new homeowner, and it seemed urgent. Likewise, in the early years of Joey’s life, we were young enough to run ourselves ragged trying to do everything: work on every skill and learning drill, coach him through every small task, try to keep him engaged, clean up after him, visit and consult every expert, and go to every seminar and meeting. As each year passed, we accepted more freedom just to say “no.” We accepted that there would be all kinds of needs and issues all the time.

We also learned more about depending upon others. I pay friends’ kids to pull my weeds these days. In raising a person with autism, there are free services and activities out in the community, and some for which you have to pay. Either way, there are good and competent folks who can enrich the life of a person who lives with autism.  

You can spend all of your time pulling weeds. You’ll have a nicer garden, a sore back, and a growing sense of futility. The job is never done.

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Missing Cushion

Our 28th wedding anniversary comes up toward the end of this month.

We’re coming up on half a year since our 24 year old son with autism, a presence for all but four of our married years, moved to his group home.

20180516_074005Someone described empty nest couples (sorry for the mixed metaphor ahead) as two people finding that “the cushion is gone.”  Two people with a relationship… what? invested in?  distracted by? absorbed with? filtered through? children wake up and find this empty space between them and start trying to scoot together across it.  Or refill it.  Or whatever else people do with empty spaces.

Deferred desires long stuffed under the cushion become visible.  Missed time with friends and extended family, skipped travels, unmade personal touches to home and yard, shrugged off study and career opportunities and piles of other hoped-for endeavors are there, but harder to pick up now that the restrictions of age, time and overworked finances have fallen into that space with them.

Old grievances come into the space.  The demands of the special need were exhausting but they buffered deeper discussions and discoveries that the couple should have shared.  Now these flop in with all of their emotional distortions and disputed memories and toxic colorization of today.

There’s pleasant stuff, too. A gentle pace of life was buried under the cushion and can be restored.  Daydreams can be shared over coffee or cocktails. Decisions can be talked out at length.  There isn’t a frayed and fragile cushion sitting there demanding urgent care.  Life doesn’t have to be lived as a constant emergency response.

The two shall become one flesh says God through Moses, Jesus and the Apostles.  With the cushion gone, the two can dare to shimmy across the couch, risk a hug, chance some words from their hearts, and get on with it again.

Transitional objects (or, should Power Rangers really “Go, go”?)

So our son with autism has a new bed coming today.

It is a change made at his request.  He managed to verbalize the desire for a new bed in his old room for visits to our house.

We’ve been buying new blankets to replace frayed old familiars.  But here’s where autism and the need for predictability comes in.  Not only are some of these old items like old friends, they have the ability to make change (e.g. a new bed) more agreeable.

20180504_094038The issue at hand is an old Power Rangers blanket.  It is fraying and, while not presently bleeding out fibrous filler, it will soon be in that dryer-clogging-expensive-appliance-wrecking place.

We want to throw it away.  We want to make the new bed a new bed, dang it.

But this is where a person-centered approach is important.  We need to make such a decision Joey’s.  We need to ask Do you want the Power Ranger blanket on your bed or is it all done?  

If he wants it, we honor that.  If it starts to come apart, then we three have the conversation explaining how it is broken and has to go.

We don’t do stuff only to and for Joey, we do it with him.

Strong mind, weak back

When advocating for our son’s placement in a group home, one of our arguments was our increasing age and the upcoming physical challenges of ’round the clock care for an adult with autism.

Now that he’s placed, our incredible wisdom is validated.

This week, Tim was diagnosed with something called “frozen shoulder.”  As the Mayo Clinic reveals,

Certain factors may increase your risk of developing frozen shoulder… People 40 and older… (Note: Tim’s about half past 40).

Even with Joey in a good group home, our age impinges on what we can do for him.  We just bought the new bed he needs, and Melissa’s call to the mattress place went something like,

My husband can come pick it up, but he’s got a shoulder thing.  Can someone there help him get the mattress on top of the van?  And can you tie it down for him?

Which is to say,

The Dignity of Risk

Tim had a chance to speak to the staff of a non-profit community support provider.  Many of the attendees wore blue in support of Autism Awareness Month.

ABS Blue April 2018It was a chance to remind these care giving allies how much they mean to families like ours.

Tim shared a story from our book, recounting how we threw a little party to offer a personal goodbye to one of our son’s music therapists before we moved to another state. He noted that educators, medical providers, therapists and all kinds of other direct support folks don’t hear from families unless and until something is wrong.  Our interactions tend to be steeped in bad news. We need to find ways to say thank you and, as the New Testament puts it, encourage one another and build one another up (1 Thessalonians 5:11).

As we shared in an earlier post, community support agencies have the heart and vision to provide all kinds of help to people with special needs and their families, but are hindered by lack of staff.  When Tim asked his audience what things families, churches, community groups and other neighbors could do to enhance their work, responses included

  • Identify people suited to care giving and encourage them to consider it as a career
  • Help the public understand the work of service providers and why they do it
  • Provide meaningful interactions and opportunities in the community for the people receiving services
  • Express gratitude to caregivers
  • Engage in advocacy work on behalf of community support agencies

One of the people present spoke of care giving as possessing the dignity of risk.  Caring for people with special needs means going down unfamiliar paths, trying out the untested, sometimes trusting intuition in opposition to common sense, and learning to center efforts on the person in our care instead of our own expectations of “what’s best.”

Families have this risk, dignity and all, dropped upon us when our loved one is diagnosed.  We accept the risk out of love and duty.

We are blessed when folks who don’t have to accept it choose the dignity of risk as a way of life.  May their tribe increase.

The harvest is plentiful, but the laborers are few. Therefore pray earnestly to the Lord of the harvest to send out laborers into his harvest.  (Luke 10:2)

Paper Trail

Melissa is reclaiming a room of the house to turn into a man cave for Tim.  Well, more of a study really since Tim lost his man card ages ago.

Anyway, this is an empty nest dividend, a chance to use space that was ignored or allowed to be thrashed during the long years of care giving.  To friggin’ enjoy parts of our house in non-care-giving ways.

20180421_180524Today we cleared out two broken down file cabinets.  They will be hauled away but oh what they held.

Well, frankly, most of it was trash.  Sure, important trash that will need to be shredded.  But stuff no longer needed.

Years of mortgage and refi paperwork from trying to strike deals to make ends meet without upending our son’s life.

All kinds of medical insurance stuff as the pursuit of more income, better coverage or simply more time to meet care giving demands worked itself out in an array of job changes and second jobs.

And of course tons of educational and social service type stuff that life with autism generates.  IEP “invitations” and outcomes that seemed like the be-all-and-end-all of life at the time.  Report cards.  Respite care accounting forms.  Our son’s participation in a University of California search for autism causes in the environment (no, they didn’t find one).  All of those pull-off-the-ends-and-lift-the-sticky Social Security Administration forms.

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Not even the tip of this iceberg.

There were a few important things to retain, but by and large the paper trail of our care giving life is heading to the garage in reinforced bags to be handed over to a shredding service.

Then there were some sentimental rescues.  Pictures of Joey, class photos from various schools, notes from teachers and others who helped Joey and our whole family over the years.

Those we boxed for various destinations – some for a shinier new file cabinet to come, of course – but others for a scrapbook for Joey.  He delights in looking at pictures of past friends, teachers, neighbors and classmates.  Will be a joy to bring a collection to grace his new home.

20180421_180647.jpgAnd you can bet that some paper will just live here with us, in wallets and purses, in drawers where we can bump into a memory in the course of daily routines, maybe in albums for us.

I mean, who else will  reminisce and smile and maybe shed a sweet tear over a picture of Joey turning his back on the camera… and on Santa?